“Emergency Department Clinical Pathway for Healthy Children with Gastroenteritis/ Dehydration” From CHOP

Today I link to and embed the outstanding Emergency Department Clinical Pathway for Healthy Children with Gastroenteritis/ Dehydration <– use this flow chart link rather than the copy in this post because the flow chart is easier to follow. I just copy links on my blog because it helps me retain the material. From The Children’s Hospital Of Philadelphia [accessed 11-26-2023]

Emergency Department Clinical Pathway for Healthy Children
with Gastroenteritis/ Dehydration

Triage
ED Nursing Pathway Standing Orders: Gastroenteritis/Dehydration

Oral Rehydration Therapy (ORT)

Definition of ORT Failure

  • > 1 emesis after ondansetron
  • Refusal to take from syringe/cup for
    > 30 mins

Hypoglycemia

  • Defined as glucose < 70 in all ages
  • Give 2mL/kg of D10W
  • Start glucose containing maintenance fluids immediately
  • Recheck glucose in 30 mins
Weight (kg) PO ondansetron
Dose (mg)
8-15 2
> 15-30 4
> 30 8
Significant hypoglycemia, straight to IV rehydration
Minimal/Mild Dehydration
  • Consider ondansetron
  • RN discharge teaching, give instruction sheet to family
  • Provide oral syringes, medicine cup
  • ORT video  
Moderate Dehydration
Beta-
hydroxybutyrate,
BOHB < 3
Beta-
hydroxybutyrate,
BOHB > 3
  • Consider ondansetron
  • RN plays ORT video  
    Provides ORT record sheet, syringe
  • Initiate ORT 20 mins after ondansetron
  • Assess PO intake 1 hr after ondansetron
ORT Success
ORT Failure
IV Rehydration
  • Basic metabolic profile
  • Treat hypoglycemia with 2 mL/kg of D10W
    • Recheck glucose every 30 mins until normal
  • NS 20 mL/kg IV
  • Consider D5NS 20 mL/kg (max 500 mL) over 60 mins to assist in ketone clearance
  • Start glucose containing maintenance fluids if initially hypoglycemic
  • ORT vs. admission
Reassess
Vital signs, clinical appearance, ongoing losses
Admit EDECU or Inpatient
EDECU Rehydration Recommendations
  • Considerations for admission:
    • Significant ongoing losses
    • Unable to tolerate PO fluids, ORT failure
    • Continued need for IV rehydration
    • Hypoglycemia or significant electrolyte abnormalities
    • Medical condition requiring inpatient care
Severe Dehydration
Posted: August 2007
Revised: August 2023

Editors: Clinical Pathways Team

 

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