See also The Outpatient Acute Gastroenteritis Guideline From CHOC Children’s,
posted on June 3, 2020 by Tom Wade MD. The post has very useful practical guidelines on the use of oral rehydration therapy.
There are two big pitfalls to consider when you consider diagnosing acute pediatric gastroenteritis.
The first is: Is it really acute viral gastroenteritis, or is it something else – a can’t miss diagnosis.
Can’t miss diagnoses that can look like acute gastroenteritis include vomitting caused by a surgical abdomen, diabetic ketoacidosis, and increased intracranial pressure.
The second big pitfall is underestimating the degree of dehydration in a case of acute gastroenteritis. Carefully look for compensated shock. Children can still die from dehydration from acute gastroenteritis even in the US and it is a common cause of pediatric death in resource-poor nations. See the PedsCases‘ podcast and transcript Dehydration In Children.
Tachypnea is an important sign of a potentially serious pediatric illness. When pediatric tachypnea is encountered, it needs to be carefully explained.
The WHO considers respiratory rate to be an essential marker for acute respiratory illness in infants and children.
According to the WHO approved standards, tachypnea is defined as over 60 breaths per minute and an infant under two months of age, over 50 in an infant to to 12 months, over 40 in a child aged 1 to 5, and over 30 in a child over five years of age.*
*From “Approach to a Child in Respiratory Distress” by Sarah.Buttle Nov 27, 2016 from PedsCases.
In this post I link to the PedsCases‘ Acute Gastroenteritis podcast and transcript by Melissa.Chiu, Apr 29, 2020.
Please review the following resources from PedsCases related to the topic above.
- Related Content:
- Podcast: Approach to Acute Diarrhea
- Podcast: Approach to Chronic Diarrhea
- Case: Acute diarrhea in a 7-year-old female
- Podcast: Dehydration in Children
- Case: Diarrhea causing dehydration in a 3-year-old male
Here are excerpts from the transcript:
Most cases of acute gastroenteritis are self-resolving and don’t require any medical treatment (2,4,5). However, dehydration from diarrhea and vomiting can be dangerous, and death from dehydration is common in the developing world (4). The primary goal in the management of dehydration is to replace fluid losses (2,4).
The way you manage dehydration depends on the level of dehydration of the child. Remember, they are split into 3 categories. Let’s talk about the management for each
category:1. For cases of minimal dehydration, where the child is well, the child can be given oral rehydration solutions (ORS) with at least 45 mEq of Na/L with regular
small feedings (2,5). When discharging the child, you should advise the parents to give 1.5x maintenance fluids equivalent of ORS. Of course, this should be calculated and a specific number should be given to the parents. Pedialyte and enfalyte are some over-the-counter options which the parents could purchase.
2. For cases of mild or moderate dehydration, where the child is no longer vomiting and is hemodynamically stable, the child should be given 50-100 mL of ORS per kg BW over 2-4 hours to replace lost fluids and ongoing losses should be replaced with additional ORS (2). Ondansetron has also been shown to decrease rates of admission and need for IV hydration in children between 6 months and 12 years of age and can be given in the ER (5,6).
3. In cases of severe dehydration, which usually presents with unstable hemodynamics and is very important to recognize, an IV or an intraosseous line should be started immediately for rapid fluid resuscitation with 20 ml/kg of normal saline (2,4). It’s important to remember not to use hypotonic solutions as there is an increased risk of hyponatremia (7). During resuscitation, labs including serum electrolytes, bicarb, BUN, creatinine, and glucose levels should be checked regularly. Depending on the degree of dehydration and response to initial fluid boluses, these children may require hospital admission.
See also The Outpatient Acute Gastroenteritis Guideline From CHOC Children’s,
posted on June 3, 2020 by Tom Wade MD. The post has very useful practical guidelines on the use of oral rehydration therapy.
