Treatment for Gastroenteritis
Oral rehydration therapy (ORT) is the cornerstone of treatment for gastroenteritis, with administration of 10 mL/kg of oral rehydration solution (ORS) for each watery stool passed and 2 mL/kg for each episode of vomiting. 1
Rehydration Therapy
Mild to Moderate Dehydration
- Use low-osmolarity oral rehydration solution (ORS) as first-line therapy
- For children: 10 mL/kg for each watery stool and 2 mL/kg for each vomiting episode 1
- Early feeding reduces stool output and duration of diarrhea by approximately 50% 1
- Continue breastfeeding throughout the diarrheal episode for infants 1
- Resume full-strength formula after initial rehydration for formula-fed infants 1
Alternative Administration Methods
- If oral intake is poorly tolerated, consider nasogastric administration of ORS 1
- While nasogastric administration is an option, evidence suggests spoon/oral administration may be more effective in some cases (62.5% rehydrated at 4 hours with spoon vs 39.3% with nasogastric tube) 2
Severe Dehydration
- Intravenous (IV) rehydration is indicated for severe dehydration or when oral/nasogastric routes fail
- Rapid fluid resuscitation with 40-60 mL/kg of isotonic crystalloid in the first hour for children with significant dehydration 1
- Transition to oral rehydration once the patient is stabilized
Dietary Management
- Implement a bland diet including bananas, rice, applesauce, and toast (BRAT diet) 1
- Avoid foods high in simple sugars and high-fat foods during rehydration 1
- Resume normal diet as soon as tolerated, typically within 24 hours of rehydration
Pharmacological Management
Antiemetics
- Ondansetron may be used to prevent vomiting and improve ORS tolerance 1
- Benefits include decreased need for IV fluids and hospitalization
Antibiotics
- Antibiotics should only be considered in specific situations: 1
- Presence of dysentery (bloody diarrhea)
- Persistent high fever
- Diarrhea lasting more than 5 days
- Stool cultures identifying a treatable pathogen
Medications to Avoid
- Antimotility drugs (e.g., loperamide) should not be given to children under 18 years with acute diarrhea 1
Monitoring and Warning Signs
Key Parameters to Monitor
- Urine output (target ≥0.5 mL/kg/h)
- Vital signs, especially blood pressure and heart rate
- Electrolyte levels, particularly sodium
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
Special Populations
Immunocompromised Patients
- May experience severe, prolonged, and sometimes fatal rotavirus diarrhea 1
- Require closer monitoring and more aggressive management
Premature Infants
- At increased risk for hospitalization from diarrheal disease 1
- May require earlier intervention with IV fluids
Malnourished Children
- At risk for a cycle of diarrhea and malnutrition 1
- Require nutritional support in addition to rehydration
Prevention
- Proper hand hygiene with soap is essential 1
- Environmental cleaning using detergents for contaminated surfaces
- Rotavirus vaccination significantly reduces gastroenteritis-related hospitalizations 1
- Food and water safety practices