Treatment of Gastroenteritis
The primary treatment for gastroenteritis is oral rehydration therapy (ORT) with appropriate oral rehydration solution (ORS), early refeeding, and selective use of medications based on severity. 1
Rehydration Strategies
Oral Rehydration
- Oral rehydration solution (ORS) should be used to replace ongoing fluid losses:
- Approximately 10 mL/kg ORS for each watery stool
- 2 mL/kg ORS for each episode of vomiting 1
- Optimal ORS composition:
- Sodium: 65-70 mEq/L
- Glucose: 75-90 mmol/L
- Potassium: 20 mEq/L 1
Intravenous Rehydration
- Reserved for cases with:
- While ORT has a slightly higher failure rate (1 in 25 patients may require IV therapy), it is associated with shorter hospital stays and fewer complications like phlebitis 4
Nutritional Management
- Breastfeeding should be continued throughout the diarrheal episode 1
- Resume age-appropriate diet during or immediately after rehydration 1
- Recommended foods include starches, cereals, yogurt, fruits, and vegetables 1
- Avoid foods high in simple sugars and fats 1
- Infants may experience mild lactose intolerance for 10-14 days after rotavirus infection, but most completely recover 2
Medication Options
Antiemetics
- Ondansetron (4 mg single dose, repeatable if needed) may facilitate oral rehydration when vomiting is present 1
- Single-dose ondansetron in emergency departments reduces IV fluid administration and hospitalization rates 5
- Caution: Avoid intravenous ondansetron administration and multiple-dose use 5
Antimotility Agents
- Bismuth subsalicylate may be considered for children over 3 years (with age-appropriate dosing) 1
- In adults, bismuth subsalicylate reduced duration of Norwalk infection from 27 to 20 hours 2
- Loperamide should NOT be given to children under 18 years with acute diarrhea 1
Antibiotics
- Generally not needed for viral gastroenteritis 2, 1
- May be considered in cases of:
- Dysentery (bloody stools)
- High fever
- Persistent watery diarrhea 1
- For travelers' diarrhea in children, azithromycin is preferred if antibiotics are necessary 1
- Avoid fluoroquinolones in children due to potential adverse effects 1
Special Populations
Children
- At highest risk for dehydration and require careful monitoring 2, 3
- Assess hydration status every 2-4 hours and monitor weight daily 1
- Warning signs requiring immediate medical attention:
- Bloody diarrhea
- Persistent vomiting
- Signs of severe dehydration
- Altered mental status
- High fever 1
Elderly
- Maintenance of good hydration is particularly important, especially for those on diuretic medication 2
- Higher risk of severe outcomes due to comorbidities and decreased physiologic reserve
Pregnant Women
- Dehydration and electrolyte imbalance pose risks to pregnancy
- No evidence indicates viral gastroenteritis agents constitute a particular threat to the fetus 2
Common Pitfalls to Avoid
- Delaying rehydration
- Using inappropriate fluids (avoid sugar-heavy sports drinks)
- Withholding food during illness
- Overuse of antibiotics for viral gastroenteritis
- Using antidiarrheal medications in young children 1
Prevention Strategies
- Vigorous handwashing with soap at appropriate intervals
- Thorough cleaning of environmental surfaces
- Safe food and water practices
- Proper handling of fecally contaminated materials 2, 1
Most cases of gastroenteritis are self-limited viral illnesses lasting a few days, with the main risk being dehydration and electrolyte imbalance 2, 6. The focus should be on preventing and treating dehydration while supporting the patient until the illness resolves.