Pediatric gastroenteritis, characterized by acute diarrheal illness, poses a significant global health challenge due to its potential to cause severe dehydration and electrolyte imbalance, especially in children under five years old. Effective management of dehydration is crucial, yet there is ongoing debate regarding the comparative effectiveness of oral rehydration therapy (ORT) versus intravenous (IV) therapy. This systematic review aimed to critically analyze and compare the effectiveness, safety, and clinical outcomes of ORT and IV therapy in the management of pediatric gastroenteritis. A comprehensive literature search was conducted across PubMed, Cochrane, ResearchGate, Cureus, and ScienceDirect databases, covering the period from the year 2004 to 2024. Studies were selected based on predefined inclusion and exclusion criteria. From an initial pool of 1,287 studies, 25 met the inclusion criteria and were included in this systematic review. The findings suggested that ORT was highly effective in managing mild to moderate dehydration in pediatric gastroenteritis, often reducing the need for hospitalization and associated costs. ORT with hypo-osmolar solutions was found to be superior in rehydration efficacy as compared to IV therapy in many cases. However, IV therapy was preferred in cases of severe dehydration or when ORT was contraindicated or failed. Balanced IV solutions, such as lactated Ringer’s, showed better outcomes in terms of plasma bicarbonate levels and reduced risk of hypokalemia as compared to normal saline. The findings highlighted the need for widespread implementation of ORT protocols in clinical practice and suggested further research to refine treatment guidelines, particularly for severe dehydration scenarios.

Keywords: Acute gastroenteritis, Oral Rehydration Therapy, Intravenous fluid therapy, Pediatric dehydration, Systematic review, Clinical outcomes.