What is the management of acute gastroenteritis?

Management of Acute Gastroenteritis

Oral rehydration therapy (ORT) with reduced osmolarity solutions is the cornerstone of management for acute gastroenteritis, as it is safer, more physiologic, and more efficacious than intravenous therapy for preventing hospitalization and treating dehydration. 1, 2

Assessment of Dehydration

The severity of dehydration guides management decisions:

• Clinical assessment is the best way to evaluate hydration status 3
• Key physical examination findings indicating significant dehydration:
  • Abnormal capillary refill
  • Abnormal skin turgor
  • Abnormal respiratory pattern 4
  • Decreased urine output
  • Lethargy or altered mental status

Rehydration Protocol

Mild Dehydration

• Oral rehydration solution (ORS): 50 mL/kg over 4 hours 1
• Administration technique:
  • Small amounts (5-15 mL) every 5-10 minutes
  • Use small spoon, oral syringe, or dropper
  • Never use a bottle for ORS (risk of overfeeding) 1

Moderate Dehydration

• ORS: 100 mL/kg over 4 hours 1
• If vomiting persists, consider ondansetron to improve tolerance of oral rehydration 1, 4
• Benefits of ondansetron:
  • Decreases vomiting
  • Improves oral intake
  • Reduces need for IV fluids
  • Shortens ED stay 4

Severe Dehydration

• Intravenous rehydration indicated for:
  • Signs of shock

  • 10% dehydration

  • Failure of oral rehydration therapy 3
• Ringer's lactate is preferred for IV rehydration in diarrheal illness 1

Nutritional Management

• Early feeding is crucial - continue or resume feeding immediately after rehydration 2, 1
• For infants:
  • Continue breastfeeding throughout rehydration 1
  • Resume full-strength formula immediately after rehydration 2
• For children:
  • Resume age-appropriate diet immediately 1
  • Consider bland/BRAT diet (Bananas, Rice, Applesauce, Toast) 1
  • Avoid spicy foods, coffee, alcohol, and foods high in simple sugars and fats 1

Common Pitfalls to Avoid

1. Delaying feeding - Research shows early feeding reduces stool output and duration of diarrhea by approximately 50% compared to gradual reintroduction of food 2

2. Diluting ORS - Do not add water, sugar, honey, or flavoring as this alters the carefully balanced electrolyte composition 1

3. Overuse of antimicrobials - Empiric antimicrobial therapy is NOT recommended for most cases of acute watery diarrhea 1

4. Overlooking glucose malabsorption - Watch for glucose in stools accompanied by dramatic increase in stool output with ORS administration (occurs in approximately 1% of cases) 2

5. Prolonged ORS use - Do not continue ORS alone for more than 24-48 hours without healthcare provider guidance 1

Follow-up and Monitoring

• Monitor hydration status regularly until corrected 1
• Track wet diapers (should have at least 4-6 wet diapers per day) 1
• Watch for signs of improving hydration (decreased lethargy, increased alertness) 1
• Reassess after 48-72 hours of treatment 1
• Consider alternative diagnoses if no improvement occurs 1

Prevention

• Implement proper hand hygiene practices 1
• Educate patients and caregivers about food and water safety 1
• Promote breastfeeding and rotavirus vaccination in young children 3