What is the treatment for acute gastroenteritis?

Treatment of Acute Gastroenteritis

Oral rehydration therapy (ORT) with low-osmolarity oral rehydration solution is the first-line treatment for acute gastroenteritis with mild to moderate dehydration, while intravenous fluids should be reserved for severe dehydration, shock, altered mental status, or failure of ORT. 1

Assessment of Dehydration

• Evaluate hydration status through physical examination:
  • Mild dehydration: Slightly dry mucous membranes, normal heart rate, normal urine output
  • Moderate dehydration: Dry mucous membranes, increased heart rate, decreased urine output
  • Severe dehydration: Very dry mucous membranes, tachycardia, minimal/no urine output, altered mental status

Rehydration Protocol

Mild to Moderate Dehydration

1. Oral Rehydration Therapy (ORT):

   • Use low-osmolarity ORS (e.g., Pedialyte, CeraLyte) 1
   • For children who cannot tolerate oral intake, consider nasogastric administration 1
   • ORT is as effective as intravenous therapy for preventing hospitalization 2
   • ORT can be initiated more quickly than IV therapy (19.9 vs 41.2 minutes) 3

2. Administration of ORS:

   • Standard WHO formula: 3.5g NaCl, 2.5g NaHCO₃, 1.5g KCl, and 20g glucose per liter of clean water 1
   • For mild dehydration: 50-100 mL/kg over 4 hours
   • For moderate dehydration: 100-150 mL/kg over 4 hours

Severe Dehydration

1. Intravenous Fluid Therapy:
   • Indicated for severe dehydration, shock, altered mental status, or ORT failure 1
   • Use isotonic fluids (lactated Ringer's or normal saline) 1
   • Initial bolus: 20 mL/kg, repeated if necessary
   • Transition to ORS once stabilized 1

Supportive Medications

1. Antiemetics:

   • Ondansetron may be used to prevent vomiting and improve ORS tolerance 1, 2
   • Has been shown to enhance compliance with ORT and decrease hospitalization rates 4

2. Medications to Avoid:

   • Antimotility drugs (e.g., loperamide) should not be given to children under 18 years 1
   • Antibiotics are generally not indicated for most cases of acute gastroenteritis 1

Nutrition Management

1. During Illness:
   • Continue breastfeeding throughout the diarrheal episode 1
   • Resume age-appropriate diet during or immediately after rehydration 1
   • Early feeding reduces stool output and duration of diarrhea by approximately 50% 1
   • Recommend bland diet (BRAT: bananas, rice, applesauce, toast) 1
   • Avoid foods high in simple sugars and high-fat foods 1

Special Considerations

Antibiotics

• Empiric antimicrobial therapy is NOT recommended for most cases of acute watery diarrhea 1
• Consider antibiotics only in specific cases:
  • Infants <3 months with suspected bacterial etiology
  • Immunocompetent patients with fever, abdominal pain, and bloody diarrhea
  • Recent international travelers with fever ≥38.5°C or signs of sepsis 1

Probiotics

• The American Gastroenterological Association suggests against probiotic use in children with acute infectious gastroenteritis in North America 1

Monitoring and Follow-up

• Monitor urine output (target ≥0.5 ml/kg/h)
• Track vital signs, especially blood pressure and heart rate
• Monitor electrolytes, particularly sodium levels 1

Warning Signs Requiring Immediate Medical Attention

• Persistent vomiting preventing ORS intake
• High stool output (>10 mL/kg/hour)
• Bloody diarrhea
• Worsening dehydration despite treatment
• Lethargy or altered mental status 1

Prevention

• Proper hand hygiene
• Food and water safety
• Rotavirus vaccination for children 1, 2
• Breastfeeding reduces incidence in young children 2