GASTROENTERITIS
HISTORY
- Duration/ Number of stools/vomits
- Blood in stools (? bacterial infection)
- Bile in vomitus (? surgical cause)
- Dehydration
PRINCIPLES
- Clinically dehydrated but not in shock – Give Oral Rehydration Solution (ORS)
- Clinically dehydrated and in hypovolumic shock – IV Fluids then ORS
TYPES OF DEHYDRATION
SEVERE
- 10% with Shock·
- CRT >2 seconds
- Altered neurological status
- Tachypnoea, tachycardia
- Low blood pressure, weak pulses
MODERATE
- 5-10% dehydration
- Dry mucous membranes
- Sunken eyes
- Reduced skin turgor
- Tachycardia
- Reduced urine output
MILD ( 5%)
- Minimal signs
Fluid deficit in ml = %dehydration x body weight x 10Add maintenance to it and infuse. |
After rehydration
Give 5ml/kg ORS after each stool to;
|
INVESTIGATIONS
- Blood culture
- Haemolytic uraemic syndrome
- Inflammatory bowel disease
- Surgical problem
| Pathogen isolated Stool pathogen | When to treat | Treatment |
| Campylobacter | Symptoms >1week OR unwell with fever/sepsis OR not improving |
Erythromycin PO 30mg/kg/day divided 4 times daily for 5-7 days |
| Salmonella | ONLY IF; bacteraemia, immunocompromised, or age <3 months | Ceftriaxone 50mg/kg/day( unwell), then oral antibiotics for 7-10 days total. (14days IV for typhoid or paratyphoid) |
| Shigella | All positive cultures | Nalidixic acid PO 60mg/kg/day divided 4 times daily for 5 days. |
| Giardia | Persistent diarrhoea/FTT | Metronidazole 5mg/kg 8 hourly for 5 days. |
PROLONGED DIARRHOEA
- Check weight, signs of malnutrition, stool for reducing substances.
- If reducing substances positive (>0.5%) try ¼ strength, ½ strength, ¾ strength and then full strength feeds. If this cause for diarrhoea, change to lactose free diet for 6 weeks.