Paeds: Gastroenteritis Flashcards
Definition
Infective diarrhoea and vomiting
Causes
Viral: Rotavirus (commonest), adenovirus, calcivirus, corona, astroviruses.
Dehydration
- Causes of death in gastroenteritis and its correction is fundamental to treatment
- Total body deficit of NA and water
Types of Dehydration
- Isnatraemic
- Hyponatraemic dehydration
- Hypernatraemic dehydration
Isnatraemic
- Loss of NA and water are proportional
- Plasma NA remains within normal range
Hyponatraemic dehydration
- Na losses exceed those of water
- Plasma NA falls
- Shift in water from extra- to intra-cellular compartments = raised brain volume = sometimes convulsions
- Common in poorly nourished in developing countries
Hypernatraemic dehydration
- Water loss exceeds sodium loss and plasma sodium concentration increased (rare)
- Results from high insensbile water loss e.g. high fever/hot, dry environment/low-sodium diarrhoea
- Shift in water form intra-to extra-cellular comaprtments
- Harder to recognise as less evidence of signs
Hypernatraemic dehydration treatment
reduce plasma sodium slowly to avoid convulsions
Causes of diarrhoea
- food intolerance
- Antibiotics
Causes of bloody diarrhoea:
- Bacterial (less common): campylobacter jejuni. shigella, salmonellae, enterotoxigenic E. coli, cholera
- NEC
- Intussusception
- IBD
Post-gastroenteritis Syndrome
- Return of watery diarrhoea - Temporary lactulose intolerance may have developed.
Post-gastroenteritis Syndrome treatment:
- Oral rehydration solution for 24h, then, introduction of a normal diet.
- Rarely need to exclude cow’s milk, disaccharides and gluten
Toddlers diarrhoea
‘Pea and carrots syndrome’ - presence of undigested vegetables
- results from underlying maturation delay in intestinal motility
- Most grow out of it by 5 yoa.
Diarrhoea mild
- Clinical features
- Dry mucous membranes
Diarrhoea mild
- Treatment
Short-term substitution of normal feeds with glucose-electrolyte solution.
Diarrhoea moderate
- Clinical features
- 5-10% body weight loss
- Thirst, restless, lethargic
- Reduced tears
- Reduced tissue elasticity
- Dry mucous membranes
- CRT: normal/prlonged
- BP: normal/low
- urine output: reduced
- Pulse: Rapid
- Eyes: sunken
- Anterior fontanelle: sunken
Diarrhoea moderate
Treatment
- Oral rehydration, give 100ml/kg over 6 hrs
- If no improvement give i.v. rehydration
Diarrhoea severe
clinical features
- > 10% body weight loss
- Drowsy, cold, sweating
- Tears: absent
- Tissue elasticity:absent
- V.dry mucous membranes
- CRT: prolonged (>2s)
- BP: low/unrecognizable
- Urine output: oliguria
- Pulse: rapid, weak, possibly impalpable
- Eyes: v. sunken
- Anterior fontanelle: v. sunken
Diarrhoea severe
Treatment
- I.V. rehydration
- Add plasma chloride to i.v. infusion once urinating
- Shocked then resuscitate with plasma volume expansion
- Monitor: fluid balance, weight, plasma electrolytes
Diarrhoea complications
Acute renal failure
Pulmonary oedema
Anti-diarrhoea drugs should they be used?
e.g. Loperamide and anti-emetics NO because a. they are ineffective b. prolonged excretion of bacteria in stools c. side-effects d. cost e. focus attention from oral rehydration
