7.3 Gastroenteritis Flashcards
When child comes in with diarrhoea and vomiting what to think?
What else could it be?
Vomiting is non specific
What kind of IV fluids for kids with gastro?
0.9% saline with 5% dextrose and KCL 20mmol/l
What is acute diarrhoea?
3 or more loose stools in 24 hours for <14 days
Bacteria accounts for how many % of gastro?
15%
Which bacteria’s for gastro most common?
Campylobacter Salmonella Ecoli Shigella S Typhi Cholera Yersinia
Antibiotics for salmonella?
Unless they’re very unwell
Otherwise prolongs excretion phase
Which bacteria for gastro mimics appendicitis?
Yersinia
3 most common parasites for diarrhoea?
Guardia
Cryptosporidium
Entamoeba
What symptoms make you think more likely bacterial gastro?
Blood and mucus in stool High fever Recent travel Food borne HUS
How to look for HUS in child based on examination?
A child who should be dehydrated but doesn’t look dehydrated cause the kidney failure is retaining fluid
Gastroenteritis main history
Vomiting Stool Intake: ?50%, type Urine Lethargy, drowsy, colour, Abdo pain, rash, bruise
Continued Gastroenteritis history?
Duration Loss of weight Sick contacts Prev. Illness FHx
What age group highest risk gastro?
Young infants
Signs of dehydration in child with Gastroenteritis?
Skin turgor Reduced cap refill Fontanelle Tach Wet nappies
DDx for Gastroenteritis?
Appendicitis Hernia Intussusception UTI Meningitis Diabetic ketoacidosis IBD HUS Inborn errors metabolism
RED FLAGS for gastro?
Blood in stool or vomit Bile in vomit Vomit, no diarrhoea Diarrhoea first then vomiting Headache >39 Young: <3m Severe abdo pain / distension
Ix for Gastroenteritis?
Usually not UEC, BGL FBE Stool: MCS, virology CXR/AXR, U/S
How to treat mild dehydration?
Frequent small volumes of oral rehydration salts
NGT rapid rehydration details?
10mL/kg/hr for 4 hours then CEASE
Rapid IV rehydration details?
10mL/kg/hr for 4 hours with N/S +5% glucose
When do you NOT use NGT rehydration?
Ileus
Reduced consciousness
Younger than 6 Mo
Medical condition: risk of fluid overload
Standard IV rehydration for mod/severe gastro is?
0.9% saline + 5% glucose + 20mmol/l KCl over 24-48hr
What is the amount of fluid calculation for IV maintenance fluids?
4,2,1mL
4 for first 10 kg
2 for second 10 kg
1 for subsequent kg
When to admit to hospital for Gastroenteritis?
Severe dehydration <6/12 High freq vomit/diarrhoea High risk complications: diabetes, renal, poor nutrition ?surgical dx Parents can’t manage Unsuccessful oral rehydration
When to commence normal oral intake?
Once can tolerate fluid and oral intake
What cause acute diarrhoea to go chronic?
Restricted intake
High volume Appel juice
Antibiotics
Antidiarrhoeals
