Diarrhoea_and_Vomiting_in_Children_Flashcards
What is the most common cause of gastroenteritis in children in the UK?
The most common cause of gastroenteritis in children in the UK is rotavirus.
How long does diarrhoea usually last in children with gastroenteritis?
Diarrhoea usually lasts for 5-7 days and stops within 2 weeks.
How long does vomiting usually last in children with gastroenteritis?
Vomiting usually lasts for 1-2 days and stops within 3 days.
What categories does NICE advocate for assessing hydration status in children?
NICE advocates using normal, dehydrated, or shocked categories for assessing hydration status in children.
What are the clinical features of clinical dehydration in children?
Clinical features of clinical dehydration in children include appearing unwell or deteriorating, decreased urine output, unchanged skin color, warm extremities, altered responsiveness (e.g., irritable, lethargic), sunken eyes, dry mucous membranes, tachycardia, tachypnoea, normal peripheral pulses, normal capillary refill time, reduced skin turgor, and normal blood pressure.
What are the clinical features of clinical shock in children?
Clinical features of clinical shock in children include decreased level of consciousness, cold extremities, pale or mottled skin, tachycardia, tachypnoea, weak peripheral pulses, prolonged capillary refill time, and hypotension.
Which children are at increased risk of dehydration?
Children at increased risk of dehydration include those younger than 1 year (especially those younger than 6 months), infants 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 tolerated supplementary fluids before presentation, infants who have stopped breastfeeding during the illness, and children with signs of malnutrition.
What features are suggestive of hypernatraemic dehydration in children?
Features suggestive of hypernatraemic dehydration in children include jittery movements, increased muscle tone, hyperreflexia, convulsions, and drowsiness or coma.
In what situations does NICE suggest doing a stool culture for children with diarrhoea and vomiting?
NICE suggests doing a stool culture if you suspect septicaemia, there is blood and/or mucus in the stool, or the child is immunocompromised.
When should you consider doing a stool culture for children with diarrhoea and vomiting?
You should consider doing a stool culture if the child has recently been abroad, the diarrhoea has not improved by day 7, or you are uncertain about the diagnosis of gastroenteritis.
What is the recommended management if clinical shock is suspected in children with diarrhoea and vomiting?
If clinical shock is suspected in children with diarrhoea and vomiting, they should be admitted for intravenous rehydration.
What is the recommended management for children with no evidence of dehydration?
For children with no evidence of dehydration, continue breastfeeding and other milk feeds, encourage fluid intake, and discourage fruit juices and carbonated drinks.
What is the recommended management if dehydration is suspected in children with diarrhoea and vomiting?
If dehydration is suspected in children with diarrhoea and vomiting, give 50 ml/kg low osmolarity oral rehydration solution (ORS) over 4 hours, plus ORS for maintenance, often and in small amounts. Continue breastfeeding and consider supplementing with usual fluids (including milk feeds or water, but not fruit juices or carbonated drinks).
A 6-year-old boy presents to the Emergency Department with his parents due to severe vomiting and diarrhoea that has persisted for two days. He is lethargic, his skin feels cool, and he has a heart rate of 140 beats per minute, a respiratory rate of 30 breaths per minute, a blood pressure of 85/50 mmHg, and a capillary refill time of 4 seconds. The child weighs 20 kg, and his blood tests indicate metabolic acidosis.
What is the most appropriate next step in managing this child?
IV 0.9% NaCl 100mL over less than 10 minutes
IV 0.9% NaCl 200mL over less than 10 minutes
IV 0.9% NaCl 300mL over less than 10 minutes
IV 0.9% NaCl 400mL over less than 10 minutes
IV 0.9% NaCl 1000mL over less than 10 minutes
IV 0.9% NaCl 200mL over less than 10 minutes
Start IV fluid resuscitation in children or young people with a bolus of 10 ml/kg over less than 10 minutes
IV 0.9% NaCl 200mL over less than 10 minutes is correct. For this child weighing 20 kg with severe dehydration and signs of shock (lethargy, cool skin, tachycardia, hypotension, delayed capillary refill), the recommended initial fluid bolus is 10 mL/kg. This amounts to 200 mL (20 mL/kg x 20 kg). Administering this volume quickly (over less than 10 minutes) is essential to restore circulating volume and improve perfusion rapidly.
IV 0.9% NaCl 100mL over less than 10 minutes is incorrect. While 100 mL of normal saline is a volume that could be considered for initial fluid resuscitation in some scenarios, it is insufficient for a child with signs of severe dehydration and hypovolemic shock. This volume is too small to provide adequate circulatory support for this child’s weight (20 kg) and clinical presentation. It would be more appropriate to start IV fluid resuscitation in this patient with a bolus of 10 mL/kg over less than 10 minutes, not 5 mL/kg.
IV 0.9% NaCl 300mL over less than 10 minutes is incorrect. A 300 mL bolus of normal saline, while better than options, may still be inappropriate for a child with severe dehydration and signs of shock. The guidelines recommend an initial 10 mL/kg boluses to stabilise circulation quickly, whereas this fluid resuscitation equates to 15 mL/kg. This could predispose this child to complications of over-resuscitation (e.g. Fluid overload or hyponatraemia).
IV 0.9% NaCl 400mL over less than 10 minutes is incorrect. The guidelines recommend an initial 10 mL/kg boluses to stabilise circulation quickly, whereas this fluid resuscitation equates to 20 mL/kg. This could predispose this child to complications of over-resuscitation (e.g. Fluid overload or hyponatraemia).
IV 0.9% NaCl 1000mL over less than 10 minutes is incorrect. Administering 1000 mL of normal saline in less than 10 minutes could risk fluid overload in a child of this size. Although rapid fluid resuscitation is necessary, the volume should be calculated based on weight (10 mL/kg), which in this case is 200 mL. Exceeding this volume significantly could lead to complications such as pulmonary oedema. This resuscitation bolus would be the equivalent of 50 mL/kg.
summarise D&V
Diarrhoea and vomiting in children
Diarrhoea and vomiting is very common in younger children. The most common cause of gastroenteritis in children in the UK is rotavirus. Much of the following is based around the 2009 NICE guidelines (please see the link for more details).
Clinical features
NICE suggest that typically:
diarrhoea usually lasts for 5-7 days and stops within 2 weeks
vomiting usually lasts for 1-2 days and stops within 3 days
When assessing hydration status NICE advocate using normal, dehydrated or shocked categories rather than the traditional normal, mild, moderate or severe categories.
Clinical dehydration
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
Clinical shock
Decreased level of consciousness
Cold extremities
Pale or mottled skin
Tachycardia
Tachypnoea
Weak peripheral pulses
Prolonged capillary refill time
Hypotension
The following children are at an increased risk of dehydration:
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
Features suggestive of hypernatraemic dehydration:
jittery movements
increased muscle tone
hyperreflexia
convulsions
drowsiness or coma
Diagnosis
NICE suggest doing a stool culture in the following situations:
you suspect septicaemia or
there is blood and/or mucus in the stool or
the child is immunocompromised
You should consider doing a stool culture if:
the child has recently been abroad or
the diarrhoea has not improved by day 7 or
you are uncertain about the diagnosis of gastroenteritis
Management
If clinical shock is suspected children should be admitted for intravenous rehydration.
For children with no evidence of dehydration
continue breastfeeding and other milk feeds
encourage fluid intake
discourage fruit juices and carbonated drinks
If dehydration is suspected:
give 50 ml/kg low osmolarity oral rehydration solution (ORS) solution over 4 hours, plus ORS solution for maintenance, often and in small amounts
continue breastfeeding
consider supplementing with usual fluids (including milk feeds or water, but not fruit juices or carbonated drinks)
