Intravenous rehydration for severe acute malnutrition with gastroenteritis: Reply

To the Editor: The results of the GASTROSAM trial reported by Maitland et al. (Oct. 2 issue) showed survival among African children with acute malnutrition and diarrhea to be similar whether they received oral hydration or intravenous hydration with lactated Ringer’s solution. We are concerned that fluid resuscitation with lactated Ringer’s solution in patients with diarrhea who have hypovolemia and acidosis may worsen hypokalemia, as suggested by the decrease in the mean potassium level in the first 8 hours. Were participants with severe hypokalemia treated with additional potassium supplements? During cholera and dysentery outbreaks among Rwandan refugees, children with malnutrition . . .