Gastroenteritis - Paediatric

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Definition

-  Inflammation/infection of the gastrointestinal tract resulting in diarrhoea +/- vomiting

 

Features

-  Common presentation in children

 

Associated S/S

-  Diarrhoea

-  If >10 days consider another Dx

-  +/- vomiting

-  If bilious consider another Dx

-  If present wo diarrhoea consider another Dx

-  +/- crampy abdo pain

-  Shock

-  +/- haematochezia

-  Dehydration

-  +/- fever (febrile child <3yrs)

 

Causes

-  Viral

-  Bacterial

-  Amoeba

 

DDx

-  UTI

-  Appendicitis

-  Acute abdomen

 

Ix

-  Vitals: tachycardia, hypotension, fever

-  Sings of dehydration

-  Abdo exam

-  Exclude peritonitis & other surgical causes

-  Urine Dipstick + Urinalysis: exclude UTI

-  +/- U&E

-  Indicated if

-  Severe dehydration

-  Co-morbidities

-  IV hydration

-  Altered conscious state (GCS)

-  If Na <130 or >150 Mx as needed

-  +/- BSL

-  +/- Stool culture esp if haematochezia

-  +/- septic workup

 

Mx

-  Rehydration

-  Many cases Mx w PO hydration

-  Small frequent feeds/fluids

-  Cup, icy pole, syringe w ORS

-  Aim for 10-20ml/kg ORS in 1/24

-  NGT

-  Safe even if vomiting

-  Most pts stop vomiting after NGT fluids

-  Rapid Rehydration

-   Must be >6 months old

-   25ml/kg/hr for 4/24

-  If >12kg may need to increase total time up to 6.5/24

-   Suitable if moderately dehydrated

-  Slow Rehydration

-   Replace defecit over 6/24

-  10ml/kg/hr if moderate

-  15ml/kg/hr if severe

-   Then maintenance fluids over next 18hrs

-  As per IV fluid maintenance rates

-  IV fluids

-  Severe dehydration or failed NGT hydration

-  Must do U&E + glucose on VBG

-   Prior to commencement

-   Then every 24hrs

-  NS Bolus of 10-20ml/kg

-   Repeat until shock corrected

-   If >40ml/kg required seek senior advice

-  Then commence maintenance +5% x weight

-   5% Dex + 0.9% NS +/- K+

-  Reassess after 4/24

-  IV/IO access

-  Hypoglycaemia: 5ml/kg 10% Dex

-  Weight 6/24

-  +/- Ondansetron

-  If vomiting & >6 months old & >8kg

-  Single dose only

-  Early feeding (normal diet) once rehydrated

-  Cease feed fortifications

-  Temporary lactose intolerance may develop --> lactose free formula 2/52

 

 

 

 

 

References

 

RCH – CPG (incl pic): www.rch.org.au/clinicalguide/cpg.cfm?doc_id=12364