What is the management for Acute Gastroenteritis (AGE) with moderate dehydration?

Management of Acute Gastroenteritis with Moderate Dehydration

For moderate dehydration (6-9% fluid deficit), oral rehydration solution (ORS) should be administered at 100 mL/kg over 2-4 hours as the first-line therapy. 1, 2

Assessment of Dehydration

• Moderate dehydration (6-9% fluid deficit) is characterized by loss of skin turgor, dry mucous membranes, and decreased urine output 2
• Rapid, deep breathing, prolonged skin retraction time, and decreased perfusion are reliable indicators of dehydration 2
• Capillary refill time correlates with fluid deficit and should be assessed, though fever and ambient temperature can affect this measurement 2

Rehydration Protocol for Moderate Dehydration

• Administer ORS containing 50-90 mEq/L of sodium at a dose of 100 mL/kg over 2-4 hours 1
• Start with small volumes (e.g., one teaspoon) using a teaspoon, syringe, or medicine dropper, then gradually increase the amount as tolerated 1
• Reassess hydration status after 2-4 hours; if still dehydrated, reestimate the fluid deficit and restart rehydration therapy 1
• Nasogastric administration of ORS may be considered for patients who cannot tolerate oral intake or refuse to drink adequately despite normal mental status 1

Replacement of Ongoing Fluid Losses

• During both rehydration and maintenance therapy, replace ongoing stool and vomit losses 1
• Replace each diarrheal stool with 10 mL/kg of ORS and each episode of emesis with 2 mL/kg of ORS 1
• For infants <10 kg: provide 60-120 mL ORS for each diarrheal stool or vomiting episode, up to ~500 mL/day 1
• For children >10 kg: provide 120-240 mL ORS for each diarrheal stool or vomiting episode, up to ~1 L/day 1

Dietary Management

• Breastfed infants should continue nursing on demand throughout the illness 1
• For bottle-fed infants, administer full-strength, lactose-free, or lactose-reduced formulas immediately upon rehydration 1
• When lactose-free formulas are unavailable, full-strength lactose-containing formulas can be used under supervision 1
• Older children should continue their usual diet during diarrhea, focusing on starches, cereals, yogurt, fruits, and vegetables 1
• Avoid foods high in simple sugars and fats 1
• Do not "rest the bowel" through fasting; feeding should begin as soon as appetite returns 2

Appropriate ORS Selection

• Low-osmolarity ORS can be given to all age groups with any cause of diarrhea 1
• Commercial formulations that can be used include Pedialyte, CeraLyte, and Enfalac Lytren 1
• Avoid using apple juice, Gatorade, and commercial soft drinks for rehydration due to their high osmolality 1, 2

When to Consider IV Therapy

• If there is progression to severe dehydration, shock, altered mental status, or failure of ORS therapy, switch to intravenous fluids 1
• Isotonic solutions such as lactated Ringer's or normal saline should be administered in these cases 1
• In patients with ketonemia, an initial course of intravenous hydration may be needed to enable tolerance of oral rehydration 1

Monitoring Response to Therapy

• Regularly assess clinical signs including skin turgor, mucous membrane moisture, and mental status 2
• Monitor stool frequency and consistency 1
• Watch for signs of treatment failure such as inability to tolerate oral rehydration, worsening dehydration, or persistent vomiting 3