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Pediatric Diarrhea: History is the Primary Diagnostic Tool

Diagnosing the cause of diarrhea is not always the most important thing we have to do. Often, pediatric patients present to the emergency department very well-appearing after one or two days of some watery diarrhea. Most of the time I don’t do any diagnostic work other than my history and physical exam – blood work and a stool PCR panel don’t change my management in an otherwise well-appearing child. The majority of children will improve without significant intervention other than supportive care and hydration at home. In the acutely ill, dehydrated and sick looking kid with a week of fever and bloody diarrhea, finding out the exact cause can be much more crucial.

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 Acute Gastroenteritis with Vomiting and/or Diarrhea Algorithm

Vomiting and/or diarrhea of recent onset not due to chronic disease, with or without fever, nausea, abdominal pain.

Articles of Interest

Gastroenteritis

There are various formulations available the most common being Pedialyte. Care should be taken to avoid hypotonic (pure water) or hypertonic (broth) solutions as these can lead to hypernatremia or hyponatremia, especially in younger child and infants. Total intake should be 30 to 50 ml/kg for the mildly dehydrated child and 60 to 80 ml/kg for the moderately dehydrated child with 25% of the goal intake administered each hour for four hours while being observed in the emergency department.

Management of Acute Gastroenteritis in Children

Oral rehydration therapy using a commercial pediatric oral rehydration solution is the preferred approach to mild or moderate dehydration. The traditional approach using “clear liquids” is inadequate. Severe dehydration requires the prompt restoration of intravascular volume through the intravenous administration of fluids followed by oral rehydration therapy. When rehydration is achieved, an age-appropriate diet should be promptly resumed. Antiemetic and antidiarrheal medications are generally not indicated and may contribute to complications. The use of antibiotics remains controversial.

Management of gastroenteritis in children

Approximate amount of ORS solution to be given in the first 04 hours. Mild to moderate (5-10%) dehydration 75 ml/kg in 4 hours.

Managing Acute Gastroenteritis Among Children

Treatment of acute diarrhea has relied upon simple and effective therapy of oral rehydration. The critical co-principle in case management of early resumption of feeding of children immediately upon rehydration has also gained wide acceptance. More recent advances in the science of diarrhea treatment include recognition for the role of zinc supplementation in reducing disease severity and occurrence, and development of an oral rehydration solution of lower osmolarity for global use. The combination of oral rehydration and early nutritional support promises to safely and effectively assist a patient through an episode of diarrhea. If the principles of therapy outlined in this report are accepted by all levels of the medical community and if education of parents includes teaching them to begin ORT at home, numerous deaths and unnecessary clinic visits and hospitalizations can be avoided. ORT is suitable for use among children throughout the world.

Probiotics no help to young kids with stomach virus

Children with stomach viruses increasingly are given probiotics to ease symptoms of vomiting and diarrhea. But a major U.S. study led by Washington University School of Medicine in St. Louis shows that a commonly used probiotic is not effective in improving symptoms in young patients with gastroenteritis.

The Treatment of Pediatric Gastroenteritis: A Comparative Analysis of Pediatric Emergency Physicians’ Practice Patterns

We observed moderate variation in reported practices in the treatment of children with acute gastroenteritis by location of practice within North America. Pediatric emergency physicians frequently administer an antiemetic, most commonly ondansetron, in children with dehydration and intractable vomiting. Nonetheless, many children with moderate dehydration, particularly in the United States, are given IV rehydration. However, given that limited data exist to guide clinicians, the rate and volume of IV fluid administration differs significantly by country of practice.

Trends in Management of Children With Acute Gastroenteritis in US Emergency Departments

Oral ondansetron reduces vomiting, the need for intravenous rehydration, and hospitalizations; however, benefits are limited to children with evidence of dehydration.

Urgent Care Management of Acute Gastroenteritis in Pediatric Patients

Although most cases of acute gastroenteritis require minimal medical intervention, dehydration and hypoglycemia may develop in cases of prolonged vomiting and diarrhea. The mainstay of treatment for patients with mild-to-moderate dehydration with acute gastroenteritis is oral rehydration solution. Antiemetics allow for improved tolerance of oral rehydration solution, and, when used appropriately, can decrease the need for intravenous fluids and hospitalization.

Resources

Raising Children

It’s important to make sure that your child has enough to drink. Give your child small amounts to drink often – for example, a few mouthfuls every 15 minutes. This will help to prevent dehydration.

StatPearls

Overall, treatment and management of children with acute gastroenteritis involve rehydration (oral or IV), diet selection, zinc supplementation, and additional therapies like probiotics.

TeachMe Paediatrics

Offer oral rehydration salt solution (ORS) as supplemental fluid to those at risk of dehydration. Give ORS solution: 50 ml/kg over 4 hours to replace the defecit plus maintenance fluid.