Treatment of Gastroenteritis
The cornerstone of gastroenteritis treatment is oral rehydration therapy (ORT) with appropriate fluid and electrolyte replacement, dietary modifications, and symptom management. 1
Rehydration Therapy
Oral Rehydration
- Oral rehydration solution (ORS) is the first-line treatment for mild to moderate dehydration 1, 2
- WHO recommends ORS containing:
- 65-70 mEq/L sodium
- 75-90 mmol/L glucose
- Prepared by mixing 3.5g NaCl, 2.5g NaHCO₃, 1.5g KCl, and 20g glucose per liter of clean water 1
- For children with vomiting, administer small, frequent volumes (e.g., 5 mL every minute) via spoon or syringe 1
- Continue ORS until clinical dehydration is corrected 1
Intravenous Rehydration
- Reserved for patients with:
- Severe dehydration
- Shock
- Altered mental status
- Failure of oral rehydration therapy 1
- Use isotonic fluids such as lactated Ringer's or normal saline 1
- Continue until pulse, perfusion, and mental status normalize 1
Dietary Management
- Continue breastfeeding in infants throughout the diarrheal episode 1
- Resume age-appropriate diet during or immediately after rehydration 1
- BRAT diet (bread, rice, applesauce, toast) may be helpful 1
- Avoid:
- Lactose-containing products
- High-osmolar dietary supplements
- Spices, coffee, and alcohol
- Foods high in simple sugars and fats 1
Pharmacological Management
Antidiarrheals
- Loperamide can be used for non-severe cases in adults:
- Start with 4 mg initially
- Then 2 mg after each loose stool
- Maximum 16 mg/day
- Continue until 12 hours after the last unformed stool 1
- Avoid loperamide in children with acute gastroenteritis and in cases of bloody diarrhea or high fever
Antiemetics
- Ondansetron may be given to patients >4 years of age to facilitate oral rehydration
- Should only be administered after adequate hydration has begun 1
Antibiotics
- Generally not indicated unless:
- Bloody diarrhea (dysentery)
- High fever
- Watery diarrhea lasting >5 days
- Specific identified pathogen requiring treatment 1
- When indicated, azithromycin (single dose 500 mg) is preferred for empiric treatment 1
Monitoring and Follow-up
Assessment of Dehydration
- Mild dehydration (3-5%): increased thirst, slightly dry mucous membranes
- Moderate dehydration (6-9%): loss of skin turgor, dry mucous membranes
- Severe dehydration (≥10%): severe lethargy, altered consciousness 1
Warning Signs Requiring Immediate Medical Attention
- Bloody diarrhea
- Persistent vomiting
- Signs of severe dehydration
- Altered mental status
- High fever 1
Special Considerations
Probiotics
- May reduce symptom severity and duration in immunocompetent patients 1
Zinc Supplementation
- Beneficial for children 6 months to 5 years with malnutrition 1
Skin Care
- Use skin barriers to prevent irritation from fecal material 1
Infection Control
- Implement proper hand hygiene and infection control measures to prevent spread 1
- Asymptomatic contacts should not receive preventive therapy 1
Most cases of viral gastroenteritis are self-limited and resolve within a few days with appropriate rehydration therapy 3. The main risk is dehydration and electrolyte imbalance, particularly in children and the elderly 3. Hospitalization and intravenous fluids should be reserved for cases with severe dehydration or when oral rehydration therapy fails 2.