What is the treatment for gastroenteritis caused by exposure to toads?

Treatment of Gastroenteritis from Toad Exposure

Oral rehydration therapy is the first-line treatment for gastroenteritis caused by toad exposure, with intravenous fluids reserved for severe dehydration, shock, or altered mental status. 1, 2

Initial Assessment and Rehydration

• Evaluate hydration status through physical examination looking for specific signs of dehydration including decreased skin turgor, dry mucous membranes, sunken eyes, altered mental status, tachycardia, and decreased urine output 2
• Categorize dehydration as:
  • Mild: <4% body weight loss
  • Moderate: 4-6% body weight loss
  • Severe: >6% body weight loss 2

Rehydration Protocol

• For mild to moderate dehydration, provide oral rehydration solution (ORS) as first-line therapy:
  • Children: 50-100 mL/kg over 3-4 hours
  • Adults: 2-4 L of ORS 1, 2
• Use commercially available low-osmolarity ORS (e.g., Pedialyte, CeraLyte) and avoid apple juice, sports drinks, and commercial soft drinks 2
• For patients who cannot tolerate oral intake, consider nasogastric administration of ORS 1, 2
• For severe dehydration, administer isotonic intravenous fluids (lactated Ringer's or normal saline) at 20 mL/kg over 30 minutes 1, 2
• Continue IV rehydration until pulse, perfusion, and mental status normalize 1

Nutritional Management

• Continue breastfeeding throughout the diarrheal episode in infants 1, 2
• Resume age-appropriate usual diet during or immediately after the rehydration process 1, 2
• Avoid fasting or withholding food, as this does not improve outcomes 2

Pharmacological Management

• Antiemetic agents such as ondansetron may be given to facilitate oral rehydration in children >4 years and adolescents with significant vomiting 1, 2
• Antimotility drugs (e.g., loperamide) should not be given to children <18 years of age with acute diarrhea 1
• Loperamide may be given to immunocompetent adults with acute watery diarrhea (4 mg initially, followed by 2 mg after each loose stool) 1, 2
• Avoid antimotility agents in cases with fever, inflammatory diarrhea, or suspected toxic megacolon 1, 2
• Probiotic preparations may be offered to reduce symptom severity and duration in immunocompetent adults and children 1

Ongoing Management

• Replace ongoing losses with ORS until diarrhea and vomiting resolve:
  • Children <10 kg: 60-120 mL ORS for each diarrheal stool/vomiting episode
  • Children >10 kg: 120-240 mL ORS for each diarrheal stool/vomiting episode
  • Adults: Ad libitum intake up to ~2 L/day 2

Infection Control Measures

• Practice proper hand hygiene after using the toilet, changing diapers, before/after food preparation, and after handling animals or their feces 1
• Personnel coming into direct contact with ill persons should wear disposable plastic gloves 1
• When contamination of clothing with fecal material is possible, personnel should also wear gowns 1
• Clean and disinfect surfaces soiled by feces or vomitus promptly 1
• Separate ill persons from well persons until at least 2 days after resolution of symptoms 1

Special Considerations

• For immunocompromised patients, more aggressive management may be needed 1
• Staff members with symptoms should be excluded from contact with susceptible persons for at least 2 days after resolution of illness, particularly food handlers 1
• In outbreak settings, identify and eliminate common sources of infection and implement appropriate infection control measures 1

Remember that most cases of viral gastroenteritis are self-limited, but proper rehydration is essential to prevent complications 3, 4.