What is the treatment protocol for adults with acute gastroenteritis?

Treatment Protocol for Adults with Acute Gastroenteritis

Oral rehydration solution (ORS) is the first-line treatment for mild to moderate dehydration in adults with acute gastroenteritis from any cause. 1, 2

Assessment of Hydration Status

• Evaluate hydration status through clinical signs: skin turgor, mental status, mucous membrane moisture, capillary refill, and vital signs 2
• Categorize dehydration as mild (3-5%), moderate (6-9%), or severe (≥10%) based on clinical presentation 2

Rehydration Therapy

Mild to Moderate Dehydration

• Administer ORS until clinical dehydration is corrected 1
• For adults (≥30 kg): provide 2-4 L of ORS over 3-4 hours 1
• Replace ongoing losses with ORS (up to ~2 L/day) until diarrhea and vomiting resolve 1, 2
• Low-osmolarity commercial ORS formulations (e.g., Pedialyte, CeraLyte) are preferred over sports drinks or juices 1, 2
• Nasogastric administration of ORS may be considered for adults who cannot tolerate oral intake 1

Severe Dehydration

• Administer isotonic intravenous fluids (lactated Ringer's or normal saline) 1, 2
• Continue IV rehydration until pulse, perfusion, and mental status normalize 1
• Transition to ORS to replace remaining deficit once patient improves 1
• In patients with ketonemia, initial IV hydration may be needed before oral rehydration can be tolerated 1

Nutritional Management

• Resume age-appropriate usual diet during or immediately after rehydration 1, 2
• Early refeeding is recommended rather than fasting or restrictive diets 1, 2
• Avoid foods high in simple sugars (soft drinks, undiluted apple juice) as they can exacerbate diarrhea through osmotic effects 2

Pharmacological Management

Antimotility Agents

• Loperamide may be given to immunocompetent adults with acute watery diarrhea once adequately hydrated 1, 3
• Avoid loperamide in cases of inflammatory diarrhea, bloody diarrhea, or diarrhea with fever 1
• Use caution with loperamide in elderly patients or those taking medications that can prolong QT interval 3
• Monitor patients taking loperamide with CYP3A4 inhibitors (e.g., itraconazole) or CYP2C8 inhibitors (e.g., gemfibrozil) for cardiac adverse reactions 3

Antiemetics

• Ondansetron may be given to facilitate tolerance of oral rehydration when vomiting is significant 1, 2, 4
• Be aware that diarrhea has been reported as a side effect of ondansetron treatment 1

Other Agents

• Probiotics may reduce symptom severity and duration in adults with infectious diarrhea 1, 2
• Zinc supplementation is primarily beneficial for children in areas with high zinc deficiency 1, 2

Infection Control Measures

• Practice proper hand hygiene after using toilet, before and after food preparation, before eating, and after handling soiled items 1, 2
• Use gloves and gowns when caring for people with diarrhea 1, 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 in cases of bloody diarrhea or inflammatory diarrhea 1, 2
• Unnecessarily restricting diet during or after rehydration 1, 2
• Overreliance on antimotility agents instead of appropriate fluid and electrolyte therapy 2, 5
• Using antimicrobial agents routinely, as viral agents are the predominant cause of acute gastroenteritis 2, 6