What is the treatment for gastroenteritis?

Treatment for Gastroenteritis

The mainstay of treatment for gastroenteritis is oral rehydration therapy (ORT), with intravenous fluids reserved for severe dehydration, shock, altered mental status, or failure of oral rehydration therapy. 1

Assessment of Dehydration

Proper assessment of dehydration severity guides treatment:

• Mild dehydration (3-5% fluid deficit): Increased thirst, slightly dry mucous membranes, normal vital signs
• Moderate dehydration (6-9% fluid deficit): Loss of skin turgor, skin tenting, dry mucous membranes, tachycardia
• Severe dehydration (≥10% fluid deficit): Severe lethargy, prolonged skin tenting, cool extremities, decreased capillary refill, rapid breathing, hypotension 1

Rehydration Protocol

Oral Rehydration

• First-line therapy for mild to moderate dehydration 2, 1
• Dosage:
  • Children: 50-100 mL/kg over 3-4 hours
  • Adults: 2-4 L of ORS
  • Replace ongoing losses with 60-120 mL for each diarrheal stool or vomiting episode 1
• Administration: Small, frequent sips if vomiting is present

Intravenous Rehydration

• Indications: Severe dehydration, shock, altered mental status, ileus, or failure of ORT 2
• Solutions: Isotonic fluids (lactated Ringer's or normal saline) 2
• Duration: Continue until pulse, perfusion, and mental status normalize 2
• Transition: Switch to oral rehydration once stabilized 2

Nutritional Management

• Early refeeding is recommended during or immediately after rehydration 2
• Breastfeeding should continue throughout the diarrheal episode in infants and children 2
• Regular diet should be resumed quickly; fasting for 24 hours is not beneficial 2
• The BRAT diet (bananas, rice, applesauce, toast) is commonly recommended but has limited supporting evidence 2, 1
• Temporarily avoid dairy products if they worsen symptoms 1

Symptomatic Treatment

Antiemetics

• Ondansetron may be given to children >4 years and adolescents to facilitate oral rehydration when vomiting is significant 2
• Has been shown to reduce the need for hospitalization and IV fluids in children 2, 3
• May increase stool volume as a side effect 2

Antimotility Agents

• Loperamide:
  • Contraindicated in children <18 years with acute diarrhea 2
  • May be used in immunocompetent adults with acute watery diarrhea 2
  • Avoid in inflammatory diarrhea, bloody diarrhea, or fever at any age 2
  • Can reduce stool volume in adults with traveler's diarrhea 2

Other Supportive Treatments

• Probiotics may reduce symptom severity and duration in immunocompetent adults and children 2
• Zinc supplementation is beneficial for children 6 months to 5 years in countries with high zinc deficiency prevalence 2
• Bismuth subsalicylate provides mild symptomatic relief in adults 1

Special Considerations

Children

• Higher risk of dehydration due to higher body surface-to-weight ratio and metabolic rate 1
• ORT is as effective as IV rehydration for preventing hospitalization 1, 4
• For every 25 children treated with ORT, one may fail and require IV therapy 4

Elderly

• Require close monitoring for dehydration signs (dry mouth, decreased urination, dizziness, confusion) 1
• More susceptible to complications from dehydration

Prevention of Transmission

• Hand hygiene is crucial after using toilet, changing diapers, before/after food preparation, after handling garbage 2
• Proper cleaning of environmental surfaces 2
• Appropriate food safety practices to avoid cross-contamination 2

Common Pitfalls to Avoid

• Overuse of antimotility agents in children or in inflammatory diarrhea
• Delayed refeeding after initial rehydration
• Using sports drinks instead of proper oral rehydration solutions
• Underestimating dehydration in vulnerable populations (very young, elderly) 1
• Unnecessary use of antibiotics for viral gastroenteritis 1

Most cases of gastroenteritis are self-limiting and require only supportive care with proper rehydration as the cornerstone of management.