Treatment of Acute Gastroenteritis
The mainstay of treatment for acute gastroenteritis is oral rehydration therapy (ORT), which should be the first-line approach for mild to moderate dehydration in both children and adults. 1
Assessment of Hydration Status
- Evaluate hydration status through physical examination, which is the most reliable method to determine severity of dehydration 2
- Look for specific signs of dehydration: decreased skin turgor, dry mucous membranes, sunken eyes, altered mental status, tachycardia, and decreased urine output 1
- Categorize dehydration as mild, moderate, or severe based on clinical presentation 1
Rehydration Therapy
Mild to Moderate Dehydration
- Provide oral rehydration solution (ORS) as first-line therapy 1
- Use commercially available low-osmolarity ORS (e.g., Pedialyte, CeraLyte) 1
- Avoid apple juice, Gatorade, and commercial soft drinks as they are not appropriate for rehydration 1
- For children who refuse ORS, nasogastric administration may be considered 1
Severe Dehydration
- Administer isotonic intravenous fluids (lactated Ringer's or normal saline) 1
- Continue IV rehydration until pulse, perfusion, and mental status normalize 1
- Once stabilized, transition to oral rehydration to replace remaining deficit 1
Maintenance and Ongoing Losses
- Replace ongoing losses with ORS until diarrhea and vomiting resolve 1
- For children <10 kg: 60-120 mL ORS for each diarrheal stool/vomiting episode (up to ~500 mL/day) 1
- For children >10 kg: 120-240 mL ORS for each diarrheal stool/vomiting episode (up to ~1 L/day) 1
- For adolescents and adults: Ad libitum intake up to ~2 L/day 1
Nutritional Management
- Continue breastfeeding throughout the diarrheal episode in infants 1
- Resume age-appropriate diet during or immediately after rehydration 1
- Avoid fasting or withholding food for 24 hours as this does not improve outcomes 1
- The BRAT (bananas, rice, applesauce, toast) diet has limited supporting evidence 1
Pharmacological Management
Antiemetics
- Consider ondansetron in children >4 years and adolescents with significant vomiting to facilitate oral rehydration 1, 3
- Ondansetron has been shown to reduce vomiting episodes, decrease need for IV fluids, and reduce hospitalization rates 1, 4
- Antiemetics should only be used after adequate hydration has been initiated, not as a substitute for fluid therapy 1
Antimotility Agents
- Loperamide may be given to immunocompetent adults with acute watery diarrhea 1
- Loperamide should NOT be given to children <18 years of age 1
- Avoid antimotility agents in cases of inflammatory diarrhea, diarrhea with fever, or suspected toxic megacolon 1
Probiotics and Supplements
- Probiotic preparations may reduce symptom severity and duration in immunocompetent patients 1
- Zinc supplementation may be beneficial for children 6 months to 5 years in countries with high prevalence of zinc deficiency 1
Prevention Measures
- Practice proper hand hygiene after using toilet, changing diapers, before/after food preparation, and after handling animals 1
- Use infection control measures including gloves, gowns, and hand hygiene with soap and water or alcohol-based sanitizers when caring for patients with diarrhea 1
Common Pitfalls to Avoid
- Delaying oral rehydration in favor of IV fluids when ORT would be sufficient 5
- Using inappropriate fluids for rehydration (sports drinks, sodas, undiluted fruit juices) 1
- Withholding food during acute gastroenteritis, which can prolong recovery 1
- Prescribing antimotility agents for children, which can lead to serious complications 1
- Failing to replace ongoing fluid losses during the illness 1