Gastroenteritis Flashcards
List the aetiology of gastroenteritis
Rotavirus (most common infantile) - vaccine at 8 + 12w
Norovirus (most common viral)
Adenovirus - <2y
Campylobacter (most common bacterial)
VTEC E.coli
Describe the signs and symptoms of gastroenteritis
- Vomiting
- Water stools
- Abdo pain/cramps - generalised, fluctuating
- Mild fever, lethargy
- Recent contact with someone with D/V
It is important to identify children at risk of what?
DEHYDRATION
Greatest risk =
- Young children (especially under 6months).
- Children passed >5 diarrhoeal stools in the last 24h
- Children vomited >2x in the last 24h
- Children stopped breast feeding during the illness
How should suspected gastroenteritis be Ix?
Stool sample for microbiology if:
- Septicaemia suspected
- blood/mucus in the stool
- immunocompromised
Measure Na+, K+, Cr, Ur and glucose if:
- IV fluids going to be used
- Sx/signs of hypernatraemia (jittery, increased muscle tone, hyperreflexia, convulsions, drowsiness, coma)
Acid-base status and [chloride] if shock suspected
How should gastroenteritis be Mx?
NOT DEHYDRATED =
- continue breast/formula feed
- oral fluids
- discourage fruit juices and carbonated drinks
- risk of dehydration = oral rehydration salt solution (ORS)
CLINCIAL DEHYDRATION = Oral Rehydration Salts (ORS) solution 50 ml/kg over 4h as well as maintenance fluids (if not tolerated then NG, then IV)
Resuscitation:
- Rapid IV/IO 20ml/kg 0.9% NaCl (10ml/kg neonates) (then multiple, then 40ml/kg, then ICU)
Maintenance:
- 100ml/kg 1st 10kg, 50ml/kg 2nd 10kg, 20ml/kg 3rd 10kg
- Body weight x % dehydration x 10
- Hypo/isonatraemia over 24h, hyperNa over 48h
FOLLOWING REHYDRATION =
- full strength milk straight away
- slowly introduce solid food
- no school 48h
What are the possible complications of gastroenteritis?
Haemolytic uraemic syndrome
Reactive complications = arthritis, carditis, urticaria, erythema nodosum and conjunctivitis
Toxic megacolon
Acquired/secondary lactose intolerance
