What are the treatment options for Gastroenteritis with moderate dehydration?

From the Guidelines

Gastroenteritis with moderate dehydration requires prompt oral rehydration therapy using an oral rehydration solution (ORS) such as Pedialyte, Ceralyte, or a homemade solution containing 6 teaspoons of sugar and 1/2 teaspoon of salt in 1 liter of clean water, as recommended by the 2017 Infectious Diseases Society of America clinical practice guidelines 1.

Key Recommendations

• Adults should consume 50-100 ml of ORS per kilogram of body weight over 3-4 hours, while children need 50-100 ml/kg over the same period, as outlined in the guidelines 1.
• Continue with regular sips every 5-10 minutes even if vomiting occurs, to ensure adequate hydration.
• Resume a normal diet as soon as tolerated, avoiding dairy products, fatty foods, and sugary drinks initially, to prevent exacerbating symptoms.

Symptom Management

• For symptom management, loperamide (Imodium) 4 mg initially followed by 2 mg after each loose stool (maximum 8 mg/day) can help control diarrhea in adults, but avoid in children or if there's fever or bloody stool, as cautioned by the guidelines 1.
• Ondansetron 4-8 mg every 8 hours for adults or 0.15 mg/kg for children can manage nausea, as recommended by the guidelines 1.

Monitoring and Follow-up

• Moderate dehydration presents with increased thirst, dry mouth, decreased urination, dizziness, and fatigue, and patients should be monitored closely for these symptoms.
• If symptoms worsen, including inability to keep fluids down, severe abdominal pain, bloody stools, or signs of severe dehydration (extreme thirst, minimal urination, severe weakness), seek immediate medical attention as intravenous fluids may be necessary, as advised by the guidelines 1.

From the Research

Treatment Options for Gastroenteritis with Moderate Dehydration

The treatment options for gastroenteritis with moderate dehydration include:

• Oral rehydration therapy (ORT)
• Intravenous rehydration therapy (IVT)
• Antiemetics to enhance the compliance of oral rehydration therapy and decrease the rate of hospitalization 2, 3

Oral Rehydration Therapy (ORT)

ORT is as effective as IVT in treating mild to moderate dehydration in acute gastroenteritis and is strongly recommended as the first line therapy 2, 4, 5

• ORT demonstrated noninferiority for the main outcome measure and was found to be favorable with secondary outcomes 5
• The time required to initiate therapy was less in the ORT group compared with the IVT group 5
• Less than one third of the ORT group required hospitalization, whereas almost half of the IVT group was hospitalized 5

Intravenous Rehydration Therapy (IVT)

IVT is an effective treatment, but some physicians prefer it over ORT 4

• There were more treatment failures with ORT, but no significant differences in weight gain, hyponatremia, or hypernatremia between ORT and IVT groups 4
• Shorter hospital stays were reported for the ORT group compared with the IVT group 4

Antiemetics

Antiemetics are not routinely recommended in treating acute gastroenteritis, but they can enhance the compliance of oral rehydration therapy and decrease the rate of hospitalization 2, 3

• Ondansetron is one of the best studied antiemetics and its role in enhancing the compliance of oral rehydration therapy and decreasing the rate of hospitalization has been proved recently 2