Gastroenteritis

Question 1

Important DDx gastroenteritis?

Answer 1

• UTI
• Appendicitis
• Other infections
• Surgical causes of acute abdo

Question 2

What are the red flags requiring careful consideration of Ddx in children presenting with ?gastro?

Answer 2

• severe pain / ado signs
• persistent diarrhoea 10d+
• blood in stool
• Very unwell
• bilious vomiting
• vomiting without diarrhoea

Question 3

When should stool micro investigation be considered in gastro?

Answer 3

• 1. diarrhoea not improving by D7 (esp if recent travel Hx)
• 2. septicaemia suspected
• 3. blood / mucous in stool
• 4. immunocompromised child

Question 4

When are blood Ix (UEC / glucose) required for children presenting with gastro?

Answer 4

• severe dehydration
• renal disease / diuretic Rx
• altered conscious state
• ‘doughy’ skin (suggesting hypernatremia)
• home therapy with excessively hypertonic solutions
• profuse or prolonged losses
• ileostomy

Question 5

Acute Mx gastro?

Answer 5

• Ondansetron (1 dose)
• Oral rehydration
• NGT if significant ongoing losses
• IV if severe, NGT fails
• Monitor rehydration

Question 6

Oral rehydration approach?

Answer 6

• Methods to help children drink: cup, icy pole etc
• Continue breast feeding
• Suggest ORS
• Early feeding
• Usual diet once rehydrated
• Temp lactose free formula (2w) if diarrhoea worse

Question 7

What is the preferred method of rehydration in children refusing oral intake?

Answer 7

NGT - even if vomiting. Most children stop vomiting after NGT started.

Question 8

How should rehydration be monitored?

Answer 8

• Bare weigh 6hrly in mod - severe dehydration receiving NGT / IV
• Reasess in 4-6h; then 8hrly to guide fluid therapy;
  Assess:
• weight change
• signs dehydration
• UO
• ongoing losses
• signs of overload