ACUTE GASTROENTERITIS

Assessment
1.

Diarrhoea and vomiting frequency, duration, ?bile, ?blood, ?mucous.

2.

Fluid intake and urine output.

3.

Level of consciousness.

4.

Must state the degree of dehydration, with signs recorded

5.

Search for other pathology mimicking gastroenteritis. Consider:

Other infections: UTI, meningitis, pneumonia, septicaemia, otitis media.

Surgical problems: appendicitis, intussusception, pyloric stenosis, obstruction, necrotising

enterocolitis.

Others: haemolytic uraemic syndrome, diabetic ketoacidosis.

Beware

A child with a tender or distended abdomen.

Toxic looking child.

Bloody diarrhoea.

Hypernatraemic dehydration difficult to assess. The child may be drowsy and irritable without
other signs.

Investigation
1.

Stool culture & virology

2.

Blood tests ONLY if clinically uncertain (eg for sodium level or of dehydration).
Do FBC, U&Es including bicarb. + Blood culture if indicated

Management
1.

Resuscitate: If shocked (>10% dehydrated) Give intravenous (iv) 20ml/kg normal saline (0.9%), and repeat
until cardiovascularly stable.

2.

Rehydrate: Replace DEFICIT + MAINTAINENCE + ONGOING LOSSES.

Deficit (ml) = weight (Kg) x (%dehydration x 10).

SHOW YOUR CALCULATIONS

Use oral rehydration therapy (ORT) with rapid rehydration over 3-4 hours (Dioralyte). [Do not be
deterred by vomiting: simply repeat ORT 20-30 minutes after vomit, use nasogastric tube (ng) if
necessary.] Continue breast feeding

After 4 hours reintroduce full strength formula milk, if formula fed

For continuing losses use 10ml/kg of ORT for each watery stool + normal feeds.

Only use iv rehydration if ng tube is not tolerated commence maintenance with 0.45% in 2.5 or 5%
+
dextrose if serum [Na ] normal or low. Replace deficit with 0.45% saline in 5% dextrose over 24hrs.
Add potassium (initially 20mmol/L) to iv fluids once urine output established. Switch to oral
rehydration as soon as possible (asap).

Hypernatraemia:
+

Rehydration must be slower due to risk of cerebral oedema and convulsions if serum Na falls too rapidly. Oral
rather than iv rehydration reduces this risk. Check serum sodium (Na) 4 hourly.
Use DIORALYTE made up with extra Na (2mmol/ml) to = 90 mmol Na/L ORS
Replace deficit over 16hrs then continue with maintenance fluids over next 24hrs.
As a guide, DO NOT serum Na by more than 5mmol/L in 24hrs
+

Use iv fluids are only if unable to rehydrate orally or with ng tube.

For iv replacement commence maintenance with 0.45% saline with 5% dextrose; replace deficit over 48hrs.
Add potassium (initially 20mmol/L) once urine output established. Use same iv fluid for maintenance & deficit
BUT revert to oral rehydration asap.

Admit:

Failed home ORT

Adverse social circumstances

Shock / Hypernatraemia

Monitor:

Nurses to keep strict intake/output record

Weigh daily

Never give:

an anti-emetic

an anti-diarrhoeal

a change to different cows milk formula

Antibiotics ONLY for:

Invasive Salmonella

Shigella if toxic

Amoebiasis

Acute giardia

Clostridium difficile toxin

More information: Guidelines folder on Fredrick Hewitt ward.

Author: Dr Mitton
Date:

October 2002

Review due:

October 2004