Makindo Medical Notes.com

Related Subjects:Sick Neonate |APGAR Scoring |Approach to Assessing Sick Child |Sick Child with Acute Gastroenteritis |Sick Child with Respiratory Distress |Sick child Diabetes Mellitus Type 1 and DKA

Introduction

• Acute gastroenteritis (AGE) is a diarrheal disease of rapid onset, with or without accompanying symptoms and signs, such as nausea, vomiting, fever, or abdominal pain.
• It is a common cause of presentation to the emergency department (ED) in children under 5 y of age. It continues to be a major cause of morbidity and mortality in developing countries.
• Most children have self-limited viral or bacterial diarrhoea, however, the dehydration caused by the disease is the focus of this article. Assess the degree of dehydration using the Table and determine the score.
• Manage the child using the algorithm provided below.

Management child over 2 months with dehydration

• Score 0/1: Continue with preferred age-appropriate diet. If vomiting offers small feeds. Consider ondansetron. Can give probiotics and zinc. No other meds. Give discharge advice. Can go home.
• Score 2 or above: Give Oral Rehydration therapy at 5-10 mls every 2-3 minutes as tolerated aiming for 25-50 ml/kg over 1 to 2 hours. If persisting vomiting or refusal consider ondansetron. reassess 1 hr. If fails to take oral intake then admit.
• Severe Dehydration/Shock: treat emergently with IV fluids. Give 20 ml/kg N-Saline. Continue oral rehydration as well. Admit.

Acute Gastroenteritis: Paediatric Emergency Pearls

• Use probiotics and oral zinc (10 mg for < 6-mo-old, 20 mg if > 6-mo-old)
• Use WHO recommended low osmolarity ORS
• No routine use of antibiotics
• No anti-secretory agents (e.g., Racecadrotil, loperamide)

When to Refer:

• Persistent/ chronic diarrhoea
• Persistent watery stools
• Malnourished child
• No clinical improvement after 3 h of ORT/IV fluids
• Persistent vomiting, lethargy, abnormal electrolytes