Diarrhoea and Vomiting in Children

Question 1

What is the most common cause of gastroenteritis in the UK?

Answer 1

Rotavirus

Question 2

According to NICE, how long does diarrhoea and how long does vomiting usually last?

Answer 2

Diarrhoea usually lasts 5-7 days and stops within 2 weeks.

Vomiting usually lasts for 1-2 days and stops within 3 days.

Question 3

What are some signs of clinical dehydration?

Answer 3

• Appears to be unwell or deteriorating
• Decreased urine output
• Skin colour unchanged
• Warm extremities
• Altered responsiveness (for example, irritable, lethargic)
• Sunken eyes
• Dry mucous membranes
• Tachycardia
• Tachypnoea
• Normal peripheral pulses
• Normal capillary refill time
• Reduced skin turgor
• Normal blood pressure

Question 4

What are some signs of clinical shock?

Answer 4

• Decreased level of consciousness
• Cold extremities
• Pale or mottled skin
• Tachycardia
• Tachypnoea
• Weak peripheral pulses
• Prolonged capillary refill time
• Hypotension

Question 5

Which children are at increased risk of dehydration?

Answer 5

• Children younger than 1 year, especially those younger than 6 months
• Infants who were of low birth weight
• Children who have passed six or more diarrhoeal stools in the past 24 hours
• Children who have vomited three times or more in the past 24 hours
• Children who have not been offered or have not been able to tolerate supplementary fluids before presentation
• Infants who have stopped breastfeeding during the illness
• Children with signs of malnutrition

Question 6

What are some signs suggestive of hypernatraemic dehydration?

Answer 6

• jittery movements
• increased muscle tone
• hyperreflexia
• convulsions
• drowsiness or coma

Question 7

According to NICE, you should do a stool culture in the following situations:

Answer 7

• You suspect septicaemia
• There is blood or mucus in the stool
• The child is immunocompromised.

Question 8

According to NICE, you should consider doing a stool culture in the following situations:

Answer 8

• The child has recently been abroad or
• The diarrhoea has not improved by day 7
• You are uncertain about the diagnosis of gastroenteritis

Question 9

What is your treatment pathway for manaing gastroenteritis in children?

Answer 9

• If shock - admit for IVI
• If no dehydration - encourage oral fluids
• If dehydration
  
  • Give 50ml/kg of Diarolyte over 4 hours in small amounts.
  • Continue breastfeeding.
  • Consider supplementing with usual water or milk but fruit juices or carbonated drinks.