Gastroenteritis and Dehydration

Question 1

Symptoms of viral gastroenteritis and clinical presentaiton

Answer 1

+/- fever

NONBILIOUS VOMITING PRECEDES DIARRHEA

mild abdo pain that imrpvoes with vomiting/diarrhea

Question 2

etiology of gastroenteritis

Answer 2

rotavirus, norovirusm adenovirus and others

Question 3

things to rule out when suspecting gastroenteritis

Answer 3

bacterial dirrhea, bowel obstruction, hepatitis, pancreatitis, appendicitis, UTI, sepsis, meningitis, DKA, increased ICP, testicular torsion

Question 4

most common complication of gastroenteritis

Answer 4

dehydration

Question 5

Note: if A kid DOESNT HAVE DIARRHEA, reconsider gastroenteritis→ you need vomiting AND diarrhea

Question 6

outline the gorelick score for dehydration

Answer 6

1 pt per feature cap refill >2, looks unwell, absent tears and dry mucous membranes

Score 0-1: mild dehydration/hydration okay (<5% total body deficit) § Score 2: moderate dehydration (5-10% deficit)

§ Score 3-4: severe dehydration (>10% deficit). Considered severe dehydration if abnormal vital signs (hypotension or tachy)

o Critical Dehydration: hypotension, very altered mental status (obtunded), extreme tachy, very
prolong cap refill, weak pulses

Question 7

outline the 4:2;1 rule for fluid requirements How much fluid would you give a dehydrated 28kg kiD?

Answer 7

first 10kg: 4ml/kg/hr

10-20kd: add 2ml/kg/he

20+kg: add 1/ml/kg/hr

Example: 28kg kid = Total 68mL/hr
• First 10kg= 40mL/hr
• 10-20kg= 20mL/hr
• 20kg+ = 8mL/hr

Question 8

management of mild dehydration

Answer 8

recall that mild is a gorelick score of 0-1. maintain hydration by offering oral fluids and meals

Question 9

management of moderate dehydration

Answer 9

oral dehydraiton with oral electrolyte solution. 1:1 sodium :sugar ratio is ideal

Question 10

management of severe hydration

Answer 10

IV rehydration with 20c/kg NS bolus over 30 min then reassess +/-admission

Question 11

critical dehydration management:

Answer 11

ABCs, IV (or IO if cannot establish access), 20-60cc/kg of NS. Check for
hypoglycemia (5cc/kg D10W in infants; 2cc/kg D25W in children)

Question 12

how to stop the diarrhea aspect of gastroenteritis

Answer 12

some role for probiotics

Question 13

t/f you sohuld give imodium to stop diarrhea

Answer 13

false. no imodium. start probiotics

Question 14

redflags when gastroenteritis isn’t getting better

Answer 14

• vomiting/diarhea lasting 10-14 days
• signs of worsening ddehydration
• blood in stool
• obvs getting worse pain/abdo distension