acute gastroenteritis etiology and fluid management

acute gastroenteritis

1. Gastroenteritis and Principles of fluid management Maimunah Uddin

2. Gastroenteritis Diarrhea is usually defined as the passage of 3 or more abnormally loose or liquid stools per day. Dysentery refers to a syndrome characterized by frequent small stools containing visible blood, often accompanied by fever, tenesmus, and abdominal pain. bloody diarrhea (larger volume bloody stools with less systemic illness) Prolonged diarrhea : lasting 7-13 days persistent diarrhea : lasting 14 days or longer Chronic diarrhea  is  defined  as loose stools that last for at least four weeks.

3. Mechanism

4. Assessment

5. Assessment

6. Labs

7. Hydration

8. ORS

9. Method of rehydration Rapid Rehydration or slow rehydration

10. Rapid Rehydration ED management 4 hours Criteria: the illness has been present for less than 48 hours, the child is older than 6 months the child does not have a chronic medical condition which affects fluid balance (e.g. chronic renal failure, cardiac conditions) Labs report in 1 hour with normal sodium

11. Rapid Rehydration Enteral route for rapid rehydration- Orally or by NGT Rehydrate rapidly by giving a total volume of 50ml/kg ORS over 4 hours either orally or via NGT using a pump for constant infusion. IV fluids Rapid Rehydration Commence 0.9% sodium chloride + 5% glucose (no potassium chloride) at 10mL/kg/hr and continue for 4 hours. (do not add maintenance fluid to this volume) Electrolytes -Results should be available and checked within1 hour Oral fluids offered during this time Reassess after 4 hours of Rapid rehydration

12. Slow rehydration

13. Slow rehydration

14. Calculation % dehydration: % dehydration x body weight (kg) x 10 Weight based

15. Other managements Antiemetic: Ondansetron Antisecretory agents: bismuth subsalicylate and racecadotril (acetorphan). Adsorbents ( eg , hydrated aluminomagnesium silicates such as smectite/ diosmectite and attapulgite, and kaolin-pectin) Antimotility drugs – Opiate receptor agonists, such as loperamide and diphenoxylate-atropine Probiotics and prebiotics Zinc Vitamin A

16. Other managements

17. Fluid Management

18. Lets calculate