Treatment for Gastroenteritis
The mainstay of treatment for gastroenteritis is oral rehydration therapy (ORT), which should be used as 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: skin turgor, mental status, mucous membrane moisture, capillary refill, and vital signs 1
- Categorize dehydration as:
- Mild (3-5% body weight lost)
- Moderate (6-9% body weight lost)
- Severe (≥10% body weight lost) 2
Rehydration Therapy
Oral Rehydration
- For mild to moderate dehydration, use oral rehydration solution (ORS) until clinical dehydration is corrected 1, 2
- Recommended dosing:
- Continue ORS to replace ongoing losses until diarrhea and vomiting resolve 1
- For children, replace each diarrheal stool/vomiting episode with:
- 60-120 mL ORS for children <10 kg
- 120-240 mL ORS for children >10 kg 2
- Use commercially available low-osmolarity ORS formulations rather than sports drinks or juices 1, 2
- Nasogastric administration of ORS may be considered for patients who cannot tolerate oral intake or refuse to drink adequately 1, 2
Intravenous Rehydration
- Reserve intravenous rehydration for patients with:
- Use isotonic fluids such as lactated Ringer's or normal saline 1
- Recommended dose: 20 mL/kg over 30 minutes for severe dehydration 2
- Continue IV rehydration until pulse, perfusion, and mental status normalize 1, 2
- Transition to ORS to replace remaining deficit once patient improves 1
Nutritional Management
- Continue breastfeeding in infants throughout the diarrheal episode 1, 2
- Resume age-appropriate 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, such as soft drinks or undiluted apple juice, as they can exacerbate diarrhea through osmotic effects 1
Pharmacological Management
- Ondansetron may be given to children >4 years and adolescents with significant vomiting to facilitate oral rehydration (dose: 0.15 mg/kg) 1, 2
- Loperamide should not be given to children <18 years with acute diarrhea 1
- Loperamide may be given to immunocompetent adults with acute watery diarrhea once adequately hydrated (4 mg initially, followed by 2 mg after each loose stool) 1, 2
- Avoid antimotility agents in cases of inflammatory diarrhea, diarrhea with fever, or suspected toxic megacolon 2
- Probiotics may reduce symptom severity and duration in both adults and children 1
- Zinc supplementation reduces diarrhea duration in children 6 months to 5 years of age in areas with high zinc deficiency prevalence or in children with signs of malnutrition 1
- Antimicrobial agents have limited usefulness since viral agents are the predominant cause of gastroenteritis 1
- Antimicrobial therapy should be considered only in specific cases such as bloody diarrhea, recent antibiotic use, exposure to certain pathogens, recent foreign travel, or immunodeficiency 1, 3
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 1, 2
- Use gloves and gowns when caring for people with diarrhea 1
- Clean and disinfect contaminated surfaces promptly 1
- Separate ill persons from well persons until at least 2 days after symptom resolution 1
Common Pitfalls to Avoid
- Delaying rehydration therapy while awaiting diagnostic testing 1
- 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 1, 2
- Unnecessarily restricting diet during or after rehydration 1, 2
- Neglecting infection control measures 1
- Relying on antidiarrheal agents instead of appropriate fluid, electrolyte, and nutritional therapy 1