Overview

• Gastroenteritis → inflammation all the way from the stomach to the intestines.
  • Most commonly viral. Very easily spread.
  • Essential to isolate patient in any healthcare environment.
• Main concern is dehydration.

Making Diagnosis

Clinical Features

• Diarrhoea + Vomiting.
• Viral ⇒ rotavirus (MOST COMMON CAUSE IN CHILDREN) or norovirus are typical.
• Bacterial ⇒
  • E.coli → spread through contact with infected faeces or contaminated water. E.coli 0157 produces the shiga toxin, causing abdominal cramps, blood diarrhoea and vomiting (haemolytic uraemic syndrome). Abx increase risk of HUS therefore should be avoided in e.coli gastroenteritis.
  • Campylobacter Jejuni (most common bacterial cause) →
  • Shigella →
  • Salmonella →
  • Bacillus Cereus →
  • Giardiasis →
• Hypernatraemic Dehydration → jittery movements, increased muscle tone, hyperreflexia, convulsions, drowsiness.
• Causes to report to HPU → campylobacter, listeria, e.coli 0157, shigella, salmonella.

Investigations

• Stool Sample Analysis → microscopy, culture and sensitivities.
  • Stool culture if (NICE) → septicaemia suspected, blood/mucus in stool, child is immunocompromised.

Management Plan

• Rehydration → Oral Rehydration Solution (75 ml/kg every 4 hrs).
  • IV Fluids → if clinically dehydrated (ie. cold extremeties, increased CRT, abnormal vital signs, weak peripheral pulses, reduced skin turgor, sunken eyes, tachycardic, dry mucous membranes).
    • Bolus → IV Bolus of 10ml/kg 0.9% NaCl. (Over less than 10 mins)
    • Maintenance → IV 0.9% NaCl + 5% Dextrose. (Maintenance for neonate = 10% dextrose)
      • First 10kg: 100ml/kg/day (=1000ml), Second 10kg: 50ml/kg/day (=1500ml), Every kg over 20kg: 20ml/kg/day.
      • Fluid Deficit (in addition to maintenance) → % dehydration x weight (kg) x 10.
        • or 200mL per 1% weight loss.
• Should resolve within 2 weeks, advice regular fluid intake, bring to hospital if deteriorates or signs of severe dehydration (pale skin, reduced consciousness, cold extremities).
• Discourage drinking of fruit juices and carbonated drinks.