Gastroenteritis and Oral Rehydration



Gastroenteritis and Oral Rehydration


Leah Harrington

Suzan Schneeweiss



Introduction



  • Gastroenteritis: diarrheal disease of rapid onset


  • May be accompanied by nausea, vomiting, fever, or abdominal pain


  • Common cause of abdominal pain presenting to the emergency department


  • Vomiting alone does not constitute gastroenteritis


  • Be cautious in labeling the child with vomiting in the absence of diarrhea as “gastroenteritis”; need thorough assessment to rule out other diagnoses


  • Infrequently requires antibiotics


Pathogens



  • Viral in up to 80%


  • Bacterial etiologies more commonly present with bloody diarrhea


Common Viral Etiologies



  • Rotavirus: age 3-15 months; fever, vomiting precedes nonbloody diarrhea; duration 5-7 days


  • Norwalk, adenovirus, torovirus


Differential Diagnosis



  • Appendicitis


  • Intussusception


  • Urinary tract infection


  • Malrotation with volvulus


  • Hemolytic uremic syndrome









Table 23.1 Common Pathogens
























BACTERIAL ETIOLOGIES


ANTIMICROBIAL TREATMENT


Clostridium difficile


Metronidazole, vancomycin


Campylobacter


Erythromycin


Shigella


Amoxicillin, sulfamethoxizole


Yersinia


Trimethoprim-sulfamethoxizole, tetracycline (> 9 yr)


PARASITIC ETIOLOGIES



Giardia lamblia


Metronidazole



History



  • Fluid intake: volume, type (hypertonic, hypotonic, ORS), frequency


  • Stool output: frequency, consistency, presence of blood or mucus


  • Emesis: frequency, volume, bilious vs nonbilious, hematemesis


  • Fever, appetite, weight loss


  • Sick contacts including daycare


  • Travel


  • Underlying illness: cardiac disease, diabetes, renal disease, cystic fibrosis


Examination



  • Determine if underlying cause of disease


  • First signs of dehydration may not be evident until reach 3-4% dehydration, more signs at 5%, and signs of severe dehydration at 9%


  • Difficult to distinguish signs of mild and moderate dehydration on basis of clinical signs; updated recommendations group these patients together (i.e., 3-9%)









Table 23.2 Symptoms and Signs of Dehydration
















































































SYMPTOM/SIGN


MINIMAL OR NO DEHYDRATION (< 3% LOSS BODY WT)


MILD TO MODERATE DEHYDRATION (3-9% LOSS BODY WT)


SEVERE DEHYDRATION (> 9% LOSS BODY WT)


Mental status


Well, alert


Normal, fatigued or restless, irritable


Apathetic, lethargic, obtunded


Fontanel


Normal


Depressed


Sunken


Thirst


Drinks normally; may refuse liquids


Thirsty, eager to drink


Drinks poorly, unable to drink


Mucous membranes


Moist


Dry


Parched


Tears


Present


Decreased


Absent


Eyes


Normal


Slightly sunken


Deeply sunken


Heart rate


Normal


Normal to increased


Tachycardia, bradycardia in severe cases


Blood pressure


Normal


Normal; orthostatic changes


Decreased


Breathing


Normal


Normal; tachypneic


Tachypnea, hyperpnea


Quality of pulses


Normal


Normal to decreased


Weak, thready, or impalpable


Capillary refill


Normal


Prolonged, > 2 sec


Prolonged, > 4 sec


Skin turgor


Instant recoil


Recoil < 2 sec


Recoil > 2 sec


Extremities


Warm


Cool


Cold, mottled, cyanotic


Urine output


Normal to decreased


Decreased


Minimal


Source: Adapted from: Duggan C, Santasham M, Glass RI. MMWR.
1992;41(RR-16):1-20
, and King CK, Glass R, Bresee JS, Duggan C. MMWR 2003;52(RR16):1-16.

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Jun 22, 2016 | Posted by in EMERGENCY MEDICINE | Comments Off on Gastroenteritis and Oral Rehydration

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