Management of Gastroenteritis
The cornerstone of gastroenteritis management is appropriate rehydration therapy, with oral rehydration solution (ORS) as the first-line treatment for mild to moderate dehydration in both children and adults. 1, 2
Assessment of Hydration Status
- Evaluate hydration status through clinical signs including skin turgor, mental status, mucous membrane moisture, capillary refill, and vital signs 2
- Categorize dehydration as:
- Mild: 3-5% fluid deficit (increased thirst, slightly dry mucous membranes) 1
- Moderate: 6-9% fluid deficit (loss of skin turgor, tenting of skin, dry mucous membranes) 1
- Severe: ≥10% fluid deficit (severe lethargy, altered mental status, prolonged skin tenting >2 seconds, cool extremities, decreased capillary refill) 1
Rehydration Therapy
Oral Rehydration
- Use reduced osmolarity ORS for mild to moderate dehydration 1, 2
- Dosage recommendations:
- Continue ORS to replace ongoing losses until diarrhea and vomiting resolve 1, 2
- Nasogastric administration of ORS may be considered for patients who cannot tolerate oral intake or refuse to drink adequately 1, 2
- Use commercially available low-osmolarity ORS formulations (e.g., Pedialyte, CeraLyte, Enfalac Lytren) rather than sports drinks or juices 1, 2
Intravenous Rehydration
- Reserve for patients with severe dehydration, shock, altered mental status, failure of oral rehydration therapy, or ileus 1, 2
- Use isotonic fluids such as lactated Ringer's or normal saline 1
- Continue IV rehydration until pulse, perfusion, and mental status normalize 1
- Transition to ORS once the patient improves 1
Nutritional Management
- Continue breastfeeding in infants throughout the diarrheal episode 1, 2
- Resume age-appropriate diet during or immediately after rehydration 2, 3
- Early refeeding is recommended rather than fasting or restrictive diets 2, 3
- Avoid foods high in simple sugars (soft drinks, undiluted apple juice) which can exacerbate diarrhea through osmotic effects 3
Pharmacological Management
Antimicrobial Therapy
- Empiric antimicrobial therapy is generally not recommended for immunocompetent children and adults with acute gastroenteritis 3
- Consider antimicrobial therapy in specific situations:
Symptomatic Treatment
- Loperamide should not be given to children <18 years with acute diarrhea 2
- Loperamide may be considered for immunocompetent adults with acute watery diarrhea once adequately hydrated 2
- Ondansetron may be given to children >4 years and adolescents to facilitate oral rehydration when vomiting is significant 2, 4
- Probiotics may reduce symptom severity and duration in both adults and children 2
- Zinc supplementation reduces diarrhea duration in children 6 months to 5 years of age in areas with high zinc deficiency prevalence 2
Infection Control Measures
- Practice proper hand hygiene after using toilet or changing diapers, before and after food preparation, before eating, and after handling soiled items 2
- Use gloves and gowns when caring for people with diarrhea 2
- Clean and disinfect contaminated surfaces promptly 2
- Separate ill persons from well persons until at least 2 days after symptom resolution 2
Common Pitfalls to Avoid
- Delaying rehydration therapy while awaiting diagnostic testing 2
- Using inappropriate fluids like apple juice or sports drinks as primary rehydration solutions 1, 2
- Administering antimotility drugs to children or in cases of bloody diarrhea 2
- Unnecessarily restricting diet during or after rehydration 2, 3
- Overreliance on antidiarrheal agents which can shift focus away from appropriate fluid, electrolyte, and nutritional therapy 1
- Neglecting to consider non-gastrointestinal causes of diarrhea and vomiting, especially in children (meningitis, sepsis, pneumonia, otitis media, urinary tract infection) 1