Paediatric Gastroenteritis
See also Gastroenteritis
under
handouts
Overview
- Vomiting is a non-specific symptom in children - do not always assume
gastroenteritis
- Surgical causes of GI symptoms must be considered
- Severe dehydration with circulatory shock is the most serious complication
- Occasionally dysenteric symptoms (high fever and bloody diarrhoea) from
invasive organisms necessitate antibiotics. Haemolytic-uraemic
syndrome is even rarer (q.v. Salmonella & Mettwurst)
- Most cases are self-limiting (maintaining hydration is the main treatment
required - antiemetics/diarrhoeals are not needed)
Diagnostic features
- Anorexia/Vomiting
- +/- Abdominal pain
- +/- Fever
- +/- Diarrhoea
Differential Diagnosis
- Other sources of infection
- Surgical causes - e.g. appendicitis, intussusception, pyloric stenosis
- Metabolic endocrine - e.g. adrenal crisis, diabetes
Aetiology
- Viral (> 90% of cases) esp rotavirus
- Bacterial causes ( < 5% )
- Protozoal ( < 5 % ) - in recurrent or chronic cases
RESUSCITATE
If shocked - poor cap refill/tachycardia
- 10ml/kg colloid/crystalloid
- Repeat every 10min until capillary refill or tachycardia normalises
Check BSL - if < 2.6 mmol/L give 4ml/kg 10% dextrose
ASSESSMENT
Exclude other causes
- Other sources of infection (see Paediatric fever)
- 'Surgical causes' - peritonism
Determine degree of dehydration
- Number of vomits/stool motions
- Number of wet nappies
- Total fluid intake
- Weight loss (weigh the child!)
Predict organism
- 'Culprit foods' - seafood, rice, poultry, dairy
- Partly cooked/reheated foods, 'Take-aways'
- Bloody diarrhoea
Contact history
- Day care
- Travel history
- Ill family members
Investigations
- BSL
- Urinalysis
- Stool MCS/OCP and viral serology
Indications
- Fever
- Abrupt onset of diarrhoea (> 4 x/day)
- Blood /mucus in stool
- Prolonged / recurrent diarrhoea
- Blood tests (EUC, FBC) - indicated if > 5% dehydration or the
child appears toxic
Signs Of Dehydration
| |
Clinical findings |
% bodyweight dehydrated |
| Mild |
Thirst
Dry mouth
Decreased tearing |
< 5% |
| Moderate |
above
+ irritability or lethargy
+ skin turgor, sunken eyes/fontanelle
+ urine output
+ HR |
5-10% |
| Severe |
above
+ drowsy/limp
+ pallor/peripheral cyanosis
+ anuric
+ BP
|
> 10% |
Management
Aim to encourage oral intake if possible
- Antibiotics - only after discussion with paediatric consultant
- Not antidiarrhoeal/antispasmodics
- Not antiemetics
Rehydrate
- Oral - if mild/moderate dehydration
- Oral fluids improve appetite but not diarrhoea
- Continue breast feeding
- Re-introduce food as child tolerates e.g. grated apple, banana, rice
cereal, jelly, toast, and dry biscuits are suitable initially (do not
deliberately withhold solids)
see Oral rehydration fluids
- IVT - if severe or failed trial of oral fluids
- Reintroduce oral fluids as soon as possible
see Fluid management in paediatrics
Disposition
Admit
- Unable to tolerate oral fluids
- Moderate/Severe dehydration
- Associated medical conditions (diabetes, ileostomy)
- Infants (< 6 months)
- Inadequate social circumstances
- Diagnosis in doubt
- Malnourished infants (at risk of metabolic acidosis and renal dysfunction)
- Haemolytic Uraemic Syndrome (Haemolytic anaemia, thrombocytopenia, uraemia)
Discharge with instructions and GP review in 24 hrs if:
- Able to tolerate fluids
- No circulatory compromise
NB Persistent diarrhoea may occur due to temporarily acquired lactose
intolerance