From the Guidelines
Hospitalization is warranted for patients with gastroenteritis who cannot keep solid food down when they exhibit signs of moderate to severe dehydration, persistent vomiting, significant electrolyte abnormalities, or failure of outpatient management, as outlined in the 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea 1.
Key Indications for Hospitalization
- Moderate to severe dehydration
- Persistent vomiting despite antiemetics
- Significant electrolyte abnormalities
- Failure of outpatient management
- Comorbidities that increase risk, such as elderly, immunocompromised, or diabetic patients
Management of Hospitalized Patients
- Initial management includes IV fluid resuscitation with isotonic solutions like normal saline or lactated Ringer's at 20-30 mL/kg in the first hour for severe dehydration, followed by maintenance fluids 1
- Antiemetics such as ondansetron 4-8 mg IV/PO every 8 hours or prochlorperazine 5-10 mg IV/IM every 6 hours can help control vomiting
- Electrolyte replacement should be guided by laboratory values
- Once vomiting subsides, oral rehydration with clear liquids should begin, gradually advancing to the BRAT diet (bananas, rice, applesauce, toast) before resuming a normal diet
Importance of Close Monitoring
Hospitalization allows for close monitoring of vital signs, intake/output, and electrolyte levels while providing supportive care until the patient can maintain adequate oral hydration and nutrition, which is crucial in preventing complications and reducing morbidity and mortality 1.
From the Research
Admission Criteria for Gastroenteritis
The decision to admit a patient to the hospital with gastroenteritis who cannot keep solid food down depends on several factors, including the severity of dehydration, presence of electrolyte abnormalities, and the patient's overall clinical condition.
- Patients with severe dehydration, hypoglycemia, or those who are unable to tolerate oral rehydration solution may require hospital admission 2, 3.
- The use of antiemetics, such as ondansetron, can help improve tolerance of oral rehydration solution and decrease the need for intravenous fluids and hospitalization 4, 5.
- Patients with mild-to-moderate dehydration can often be managed with oral rehydration solution and antiemetics, and may not require hospital admission 2, 6.
High-Risk Patients
Certain patients are at higher risk for complications from gastroenteritis and may require closer monitoring or hospital admission, including:
- Older adults or young children
- Immunocompromised patients
- Patients with underlying medical conditions
- Patients with severe symptoms, such as persistent vomiting or diarrhea, or signs of dehydration 3, 6.
Treatment and Management
The primary goal of treatment for gastroenteritis is to prevent dehydration and manage symptoms.
- Oral rehydration solution is the mainstay of treatment for mild-to-moderately dehydrated patients 2, 6.
- Antiemetics, such as ondansetron, can be used to improve tolerance of oral rehydration solution and decrease the need for intravenous fluids and hospitalization 4, 5.
- Hospital admission may be necessary for patients who require intravenous fluids, have severe dehydration or electrolyte abnormalities, or are at high risk for complications 2, 3.