What is the management of viral gastroenteritis?

Management of Viral Gastroenteritis

Viral gastroenteritis should be managed primarily with oral rehydration therapy (ORT) to prevent and treat dehydration, which is the main risk of this self-limited illness. 1

Primary Treatment Approach

Rehydration Strategy

• Oral rehydration therapy (ORT) is the cornerstone of treatment for viral gastroenteritis in both children and adults 1, 2
• ORT is as effective as intravenous (IV) fluid therapy for mild to moderate dehydration 2
• IV fluids should be reserved only for cases with:
  • Severe dehydration
  • Inability to tolerate oral fluids
  • Caregiver inability to provide adequate oral rehydration 1

Rehydration Solutions

• Children respond well to oral rehydration solutions containing physiological concentrations of glucose and electrolytes 1, 2
• For adults, maintenance of good hydration is crucial, particularly in:
  • Elderly patients
  • Those taking diuretic medications 1
• Commercial options include:
  • Pedialyte (balanced electrolytes)
  • Sports drinks like Gatorade (though may cause persistent hypokalemia) 3
  • WHO oral rehydration solution (reduced osmolarity formulations are more effective) 4

Special Population Considerations

Children

• Breast milk has a protective effect and most infants can be "fed through" an episode 1
• Children may develop temporary lactose intolerance (10-14 days for rotavirus) 1
• Judicious use of ondansetron can increase success of oral rehydration by reducing vomiting 2

Elderly

• At higher risk due to:
  • Waning antibody levels
  • Use of diuretic medications
  • Underlying debility 1
• Require closer monitoring for dehydration and electrolyte imbalances

Pregnant Women

• No evidence that viral gastroenteritis poses particular threat beyond general risks of dehydration 1
• Viremic states are not known to occur, so risk of transplacental exposure is likely minimal 1

Neonates

• Term infants have maternal antibody protection in first months of life
• Preterm infants lack adequate maternal antibody and are at increased risk 1

Symptomatic Treatment

• Bismuth subsalicylate may reduce duration of Norwalk infection (from 27 to 20 hours) 1
• Laboratory testing (serum electrolytes, creatinine, glucose) generally unnecessary except in severe cases requiring hospitalization 2

Diet Recommendations

• Early resumption of regular feeding is recommended after initial rehydration 4
• A yogurt/rice diet can be allowed as tolerated 3

Prevention Measures

Hand Hygiene

• Vigorous handwashing with soap is necessary to control spread 1
• Special handwashing products are not required as some commercial preparations are ineffective against rotavirus 1

Environmental Cleaning

• Thorough cleaning of environmental surfaces is required 1
• Detergents should be used for laundering contaminated linens and clothing 1

Vaccination

• Rotavirus vaccine is important for prevention in children 2
• Norovirus vaccines are in development with promising results 2

Common Pitfalls to Avoid

• Delaying oral rehydration therapy in favor of IV fluids when not necessary
• Unnecessary laboratory testing in mild to moderate cases
• Withholding food during illness (early feeding should be encouraged)
• Inadequate attention to hand hygiene and environmental cleaning, which can lead to ongoing transmission
• Failure to recognize higher risk in elderly patients and those on diuretics

Remember that viral gastroenteritis is typically self-limited, with the main goal of treatment being to prevent complications from dehydration and electrolyte imbalance 1, 2.