Initial Management of Ileus in Pediatric Patients
Immediately initiate isotonic intravenous fluids (lactated Ringer's solution or normal saline) as the cornerstone of treatment, since oral rehydration is contraindicated and will worsen abdominal distention in the presence of ileus. 1
Fluid Resuscitation Protocol
- Administer isotonic IV fluids exclusively—lactated Ringer's solution or normal saline are the appropriate choices 1
- For children >10 kg with signs of dehydration or shock, give initial boluses of 20 mL/kg 1
- Continue IV rehydration until pulse, perfusion, and mental status normalize and there is no evidence of ileus 1
- Never attempt oral rehydration therapy when ileus is present, as it fails in this setting and exacerbates abdominal distention 1
- Once rehydration is complete, transition to maintenance IV fluids 1
Medication Management
- Immediately discontinue all contributing medications including antimotility agents (especially loperamide), anticholinergic drugs, antidiarrheal agents, and opioids, as these aggravate ileus 1
- Never use antimotility drugs like loperamide in children with ileus or suspected ileus, as this can lead to paralytic ileus and severe complications 1
Electrolyte Correction
- Monitor and replace potassium, sodium, and other electrolytes as needed 1, 2
- Check serum electrolytes if clinical signs suggest abnormalities 1
- Correction of electrolyte abnormalities is a fundamental supportive measure alongside IV hydration 2
Clinical Monitoring Parameters
- Continuously assess vital signs including pulse, perfusion, and mental status 1
- Monitor for return of bowel function by assessing passage of flatus or stool 1
- Reassess hydration status frequently during treatment 3
Critical Pitfall to Avoid
The most dangerous error is attempting oral rehydration in the presence of ileus—this represents a contraindication that can worsen the clinical picture rather than improve it, as the dysfunctional bowel cannot handle oral intake and will develop further distention 1. The Infectious Diseases Society of America provides strong evidence (moderate quality) that isotonic IV fluids must be used when ileus is present 1.