The recently published research article in the journal [1] on the above topic addresses an important ‘felt-need’ of the practicing pediatricians. We wish to seek clarifications on certain issues.

In this study the children of infantile age group, particularly those between 6 to 12 months, were excluded. This age group contributes to almost half of the disease burden of rotavirus associated diarrhea [2]. Further, severe dehydration is more commonly seen with cholera than rotavirus diarrhea [3]. Thus, stool culture for Vibrio cholera or a rapid card kit test for rotavirus could have been beneficial and would have added value to the present study.

Authors have mentioned that patients with systemic illnesses were excluded from the study, but the nature of these systemic illnesses was not clearly elucidated. Conditions like diabetic ketoacidosis, diabetes insipidus, burnsetc can also lead to dehydration in children. Whether diarrhea in these children was accompanied by any of the above mentioned conditions was not clarified [4].

Whether the mean duration of symptoms were considered from the beginning of the illness or after admission of the patient to the hospital needs to be elaborated as majority of the children enrolled in the study had acute asymptomatic hyponatremia [1].

REFERENCES

1. Naseem M, Dubey AP, Mishra TK, Singh R. Effect of rehydration with normal saline versus ringer lactate on serum sodium level of children with acute diarrhea and severe dehydration: A randomized controlled trial. Indian Pediatr. 2020;57:519-22.

2. Giri S, Nair NP, Mathew A, Manohar B, Simon A, Singh T, et al. Rotavirus gastroenteritis in Indian children< 5 years hospitalized for diarrhoea, 2012 to 2016. BMC Public Health. 2019;19:69.

3. Siddique AK, Ahmed S, Iqbal A. Epidemiology of rotavirus and cholera in children aged less than five years in rural Bangladesh. J Health Popul Nutr. 2011;29:1-8.

4. Zieg J. Pathophysiology of hyponatremia in children. Front Pediatr. 2017;16:213.