What is the treatment for viral gastroenteritis?

Treatment for Viral Gastroenteritis

Oral rehydration therapy (ORT) is the primary treatment for viral gastroenteritis, as the main risks are dehydration and electrolyte imbalance. 1

Assessment of Dehydration

Evaluate dehydration severity based on:

• Capillary refill time (>2 seconds indicates dehydration)
• Skin turgor
• Respiratory pattern
• Heart rate (tachycardia >90 bpm)
• Mental status
• Oral intake tolerance 1

Severe dehydration may present with:

• Inability to tolerate oral fluids
• Severe abdominal pain
• Altered mental status
• More than 6 bloody stools per day 1

Treatment Algorithm

Mild Dehydration

• Manage at home with oral rehydration therapy
• Half-strength apple juice followed by child's preferred liquids is effective 2
• Continue normal feeding during illness 1
• Avoid foods high in simple sugars as they can worsen diarrhea 1

Moderate Dehydration

• Oral rehydration solutions are recommended 2
• Ondansetron may be given to children >4 years to facilitate oral rehydration tolerance if vomiting is present 1
• Resume age-appropriate diet during or immediately after rehydration 1

Severe Dehydration

• Hospitalization and intravenous fluid therapy are indicated for:
  • Patients with severe dehydration
  • Inability to tolerate oral fluids
  • Altered mental status
  • Signs of shock 1, 2

Special Considerations

Age-Specific Concerns

• Children under 3 years are at higher risk for severe dehydration 1
• Breastfed infants can usually continue nursing through the illness 1

Medication Considerations

• Antimotility drugs (e.g., loperamide) should not be given to children <18 years 1
• Antimotility agents should be avoided in cases of inflammatory diarrhea or diarrhea with fever 1
• For immunocompromised patients with specific viral causes:
  • Cidofovir may be considered for severe adenovirus-associated diarrhea 1
  • Ganciclovir is recommended for CMV enteritis 1

Prevention Strategies

• Rigorous handwashing with soap and water for at least 20 seconds 1
• Rotavirus vaccination is strongly recommended 1, 2
• Food hygiene measures 1
• Exclusion of ill individuals from food handling until 48-72 hours after symptom resolution 1

Common Pitfalls to Avoid

1. Overreliance on IV fluids: ORT is as effective as IV therapy for mild to moderate dehydration 3
2. Unnecessary laboratory testing: Serum electrolytes and other tests are usually not necessary except in severe cases requiring hospitalization 4
3. Inappropriate use of antimotility agents: These can be harmful in children and in cases of inflammatory diarrhea 1
4. Discontinuing feeding: Normal feeding should be continued during illness to decrease intestinal permeability and reduce illness duration 1
5. Neglecting social support assessment: Social support deficiency is a risk factor for dehydration 1

Viral gastroenteritis is typically self-limiting, with symptoms lasting from 24 hours to 7 days depending on the causative virus 1, 5. The focus of treatment should remain on preventing and treating dehydration while supporting nutritional needs until the viral infection resolves.