What are the admission criteria for gastroenteritis?

From the Guidelines

Patients with gastroenteritis should be admitted to the hospital if they are systemically unwell, suspected of having acute severe colitis, or exhibit signs of severe dehydration, hemodynamic instability, or significant electrolyte abnormalities, as indicated by the most recent guidelines 1. When evaluating patients with gastroenteritis, it is essential to consider their overall clinical presentation, including symptoms such as persistent vomiting, severe abdominal pain, and bloody diarrhea, which may suggest complications like inflammatory or infectious colitis.

• Key factors that warrant hospital admission include:
  • Severe dehydration, characterized by decreased skin turgor, dry mucous membranes, tachycardia, and hypotension
  • Hemodynamic instability, which can lead to circulatory compromise and organ dysfunction
  • Significant electrolyte disturbances, particularly sodium <130 or >150 mEq/L, potassium <3.0 or >5.5 mEq/L
  • Acute kidney injury, indicated by a creatinine elevation >0.3 mg/dL from baseline
  • Immunocompromised status, pregnancy, or extremes of age, which can increase the risk of complications
• The guidelines also emphasize the importance of evaluating patients with diarrhea/colitis grade 2 or higher, as defined in Table 1 of the NCCN guidelines 1, which may require abdominal/pelvic CT with contrast, gastrointestinal consultation, and further evaluation, such as colonoscopy or flexible sigmoidoscopy.
• Additionally, measurement of fecal lactoferrin and calprotectin, markers of inflammation, should be considered as part of the initial workup, depending on institutional availability, as they can help establish the etiology of the problem and assess the likelihood of needing more aggressive management approaches 1.

From the Research

Gastroenteritis Admission Criteria

The admission criteria for gastroenteritis are primarily based on the severity of dehydration and the presence of complications.

• Severe dehydration is a key indicator for hospital admission, as it can lead to serious complications if not properly managed 2.
• Patients with mild-to-moderate dehydration can often be treated with oral rehydration solution and may not require hospitalization 2.
• Certain high-risk groups, such as the elderly, young children, and immunocompromised individuals, may require closer monitoring and potentially hospitalization due to a higher risk of complications 3.

Factors Influencing Admission

Several factors can influence the decision to admit a patient with gastroenteritis, including:

• Presence of hypoglycemia, which can complicate dehydration and require more intensive treatment 2.
• Underlying medical conditions, such as diabetes, which can increase the risk of dehydration and electrolyte imbalances 4.
• Severity of symptoms, such as prolonged vomiting and diarrhea, which can lead to dehydration and electrolyte imbalances 5.

Management and Treatment

The management and treatment of gastroenteritis are crucial in determining the need for hospital admission.

• Oral rehydration solution is the mainstay of treatment for mild-to-moderately dehydrated patients 2.
• Antiemetics can be used to improve tolerance of oral rehydration solution and reduce the need for intravenous fluids and hospitalization 2.
• In severe cases, intravenous fluids and electrolyte replacement may be necessary to manage dehydration and electrolyte imbalances 6.