Gastro - gastroenteritis and dehydration Flashcards
what causes gastroenteritis
rotavirus (most common, 2y/o during winter) norovirus cholera enterotoxigenic E coli Campylobacter jejuni Shigella Salmonella Giardia Cryptosporidium
presentation of gastroenteritis
vomiting/nausea abdominal pain fever diarrhoea dehydration recent contact with someone who has diarrhoea recent travel abroad
signs of dehydration
reduced urine output prolonged cap refill time reduced GCS sunken eyes reduced skin turgor dry mucus membranes (no tears made) increased HR/RR
investigation for gastroenteritis
usually none are needed
stool culture if septic, immunocompromised, travel or not cleared up in a week
assess dehydration
isonatraemic and hyponatraemic dehydration
why do they get it?
whats the risk?
who is more likely to get it?
in dehydration Na and H20 are both lost together
can become hyponatraemic if they drink lots of water but with no Na in it
this leads to a shift of water from the low osmotic pressure blood vessels into the tissues (intracellular) - this increases brain volume and can cause seizures
this form of dehydration is more common in developing countries
Hypernatraemic dehydration
why?
risks?
what if high blood glucose is detected
Usually from insensible losses (sweating from fever/hot environment, or diarrhoea)
this means blood is hypertonic and fluid moves into the blood from the tissues
this can cause cerebral shrinkage (^tone, ^reflexes vGCS etc)
can get transient hyperglycaemia which doesnt need treatment
management of gastroenteritis: no clinical dehydration
continue feeding
if risk of dehydration - oral rehydration solution
management of gastroenteritis: clinical dehydration is present
oral rehydration solution - little and often
50mls/kg/24hours - fluid replacement
if vomiting lots or inadequate intake - NG tube
management of gastroenteritis: patient in shock
0.9% NaCl bolus
if in shock - 100mls/kg (10% body weight fluid lost)
if not in shock 50mls/kg (5% body weight fluid lost)
0.9%NaCl+/- glucose5%
?K+ IV if needed
avoid fruit juices and fizzy drinks
management of gastroenteritis: hypernatraemia present
slowly correct fluid deficit - else you risk cerebral oedema and seizures etc
management of gastroenteritis: do they need any drugs?
nope - no antidiarrheoeal drugs
not even antibiotics unless there is sepsis, or some bacteria
post gastroenteritis syndrome
sometimes get a transient lactose intolerance
- watery diarrhoea
oral rehydration
