In this section
Is the diagnosis of gastroenteritis correct?:
The following features may occur in gastroenteritis, but should prompt careful consideration of differential diagnoses & review by a senior doctor:
Consider important differential diagnoses:
Consider the diagnosis carefully if there is
Are there significant comorbidities /risk-factors?
RED FLAGS: Children with the following require Senior Medical Assessment
4. Degree of dehydration, see dehydration guideline:
In most children with gastroenteritis no investigations are required
Faecal samples may be collected for microbiological culture if the child has significant associated abdominal pain or blood in the motions, as a bacterial cause of gastroenteritis is more likely. However these results usually don't alter treatment.
Blood tests (electrolytes, glucose) are not necessary in simple gastroenteritis but are required for:
Ondansetron drug dose
Table 1: Ondansetron wafer dose
Trial of oral fluids in the emergency department:
Nasogastric Rehydration (NGTR)
RAPID NASOGASTRIC REHYDRATION:
Table 2: Recommended hourly rate for RAPID NASOGASTRIC REHYDRATION (Not intravenous rehydration)
SLOWER NASOGASTRIC REHYDRATION:
Slower rehydration is preferred for the following patients:
Replacing deficit over first 6 hours and then daily maintenance over the next 18 hours. To calculate hourly rate, see table 3:
Table 3: recommended hourly rate for SLOWER NASOGASTRIC REHYRATION
The calculated amounts do not need to be modified for exact degree of dehydration and should be used for patients with moderate or severe dehydration based on clinical signs.
DEGREE OF DEHYDRATION
mls/hr0 - 6 hrs
mls/hr7 - 24 hrs
285 for 7 hrs*
85for 17 hrs**
300for 10 hrs*
115for 14 hrs**
* RCH enteral pumps deliver a maximum of 300 ml/hr;** ie residual maintenance delivered over shorter time course
Ongoing profuse losses during NGT rehydration:
IV Fluids see guideline:
Table 4: Recommended starting rate for IV REHYDRATION AFTER INIITIAL BOLUSES (0-24 hours)
DEGREE OF DEHYDRATION Moderate or Severe [mls/hr]
After 1st 24 hours, if needed, use Standard Intravenous Fluids unless abnormal ongoing losses or electrolyte disturbance.
For advice and inter-hospital (including ICU level) transfers ring the Sick Child Hotline: (03) 9345 7007
Discharge after RAPID nasogastric rehydration:Medical review before discharge required if:- < 4% wt gain- Signs of dehydration or otherwise unwell- >=3 large stools during rehydration- Abdominal pain worsening
Advice and handout on gastroenteritis should be given to parents before discharge & encourage review the next day with the GP.
Anti-diarrhoeals and maxalon are not recommended.
Information Specific to RCH
When admitted, children with gastroenteritis are usually admitted under the General Paediatric Team, and often to the Short Stay Unit.
Ondansetron wafers must have consultant approval prior to administration.