GASTROENTERITIS Flashcards
MANAGEMENT
MILD / MODERATE DEHYDRATION
Oral Rehydration Solution 50-100 mL/kg of fluid. in first 3-4 hours
Pedialyte, Breast milk, diluted apple juice (1:1 juice:water)
Children under 3 months should NOT be given free water
Ondansetron:
2 mg < 15 kg
4 mg > 15 kg
8 mg > 30 kg
SEVERE DEHYDRATION
20 ml / kg IV bolus NS over 15-20 min or rapid push
Monitor HR, BP, mental status, urine output
Repeat until perfusion improves and urine output is adequate
Up to 60 ml/kg may be needed in the first hour for shock
THEN
Maintenance 4 cc / hr for 1st 10 kg, 2 cc / hr for 10-20 kg, 1 cc / hr per kg for every kg > 20 kg
D5 NS + 20 mEq/L KCL if isotonic dehydration after the first week of life
D5 1/2 NS + 20 mEq KCL if hypernatremic dehydration
D10 Water day 1 of life
D5 1/2 NS on day 5-7
HYPOGLYCEMIA
5 cc / kg D10 W - neonate
2 cc / kg D25 W - infant
1 cc / kg D50 W - child
INVESTIGATIONS
Indications: neonates, moderate / severe dehydration requiring IV crystalloids, medically fragile, AMS
Bedside glucose in all pts with AMS
Stool cultures:
Indications: bloody or mucoid stool, travel to high risk country, highly febrile, 10 stools / 24 hrs, blood in stool
E Coli 0157:H7: stool culture, blood (hemolysis, thrombocytopenia, AKI)
Ultrasound: bloody stools with no signs of infection
DOCUMENTATION
Ask about:
Vomit
Bloody Diarrhea
Abdominal Pain
Urine Output
Recent exposure to sick contacts, travel to endemic areas, unpasturized milk, undercooked meat, contaminated produce
Pre-illness weight
MILD DEHYDRATION
Pre-illness weight vs. weight on presentation to ED is the gold standard
3-5% weight loss
Alert
Thristy
Heart Rate Normal
BP Normal
Respirations Normal
Fontanel or eyes Normal
Tears present
Mucus membranes moist
Skin Turgor normal
Cap Refill normal
Pulses present
Urine output normal
MODERATE DEHYDRATION
Pre-illness weight vs. weight on presentation to ED is the gold standard
6-10% weight loss
Drowsy
Restless
Tachycardia
BP Orthostatic
Respirations Deep
Fontanel or eyes Slightly depressed
Tears +/-
Mucus membranes Dry
Skin Turgor Reduced
Cap Refill > 2 secs
Pulses weak
Urine output oliguria
SEVERE DEHYRATION
Pre-illness weight vs. weight on presentation to ED is the gold standard
9-15% weight loss
Lethargic
Cold, mottled limbs
Tachycardic
Hypotension
Respirations Deep and rapid
Sunken Fontanel or eyes
Tears absent
Mucus membranes very dry
Skin Turgor tenting
Cap Refill»_space; 2 secs
Pulses not palpable
Urine output anuria
DISPOSITION
Discharge if tolerating oral rehydration, adequate urine output, ongoing losses are minimized
Continue normal DAT, consider high complex carbs, lean meats, vegetables, fruits, yogurt in diarrhea
DDX
Gastroenteritis
Bacterial Colitis
Appendicitis
Intussuseption
Hirschprung
Partial Obstruction
IBD
Hemolytic Uremic Syndrome
