Acute Gastroenteritis

(including management of dehydration)
does not include: Dysentery protocol

Important points in history

Note - vomiting without diarrhoea is often NOT gastroenteritis, exclude other causes eg. UTI, appendicitis, sepsis, poisoning, DKA, raised ICP

Important points on examination

Relevant Investigations

Indications for Admission

Drug Treatment

Assessing Hydration

For all children with diarrhoea, hydration status should be classified as severe dehydration, some dehydration or no dehydration and appropriate treatment given.

Classification Signs or Symptoms Treatment
Severe Dehydration Two or more of the following signs:
  • Lethargy/unconsciousness
  • Sunken Eyes
  • Unable to drink/drinks poorly
  • Skin pinch goes back very slowly (≥ 2 seconds)
Some Dehydration Two or more of the following signs:
  • Restlessness/irritability
  • Sunken eyes
  • Drinks eagerly/thirsty
  • Skin pinch goes back slowly
No dehydration Not enough signs to classify as some or severe dehydration PLAN A

Plan C - Fluid management of SEVERE dehydration (Adequately nourished child)

(for malnourished child malnutrition chapter)

Give Ringer's Lactate Solution (or if not available Normal Saline) divided as follows:

First, give 30mls/kg in Then, give 70mls/kg in
<12 months 1 hour* 5 hours
>12 months 30 minutes* 2.5 hours

* Repeat if radial pulse is still very weak or not detectable.

When severe dehydration is corrected, prescribe Zinc

Plan B - Fluid management of SOME dehydration (Adequately nourished child)

(for malnourished child malnutrition chapter)

These children can in general be given ORS and observed for about 4 hours (usually in the short stay ward of A and E)

Give the child 75ml/kg of ORS over 4 hours to drink. If the weight is not known you can use the following approximations:

Weight Age * Amount of ORS in 4 hours
<6kg <4 months 200 - 400 mls
6 - 10 kg 4 - 12 months 400 - 700 mls
10-12 kg 12 months - 2 years 700 - 900 mls
12-19 kg 2 - 5 years 900 - 1400 mls
19-50 kg 5 - 15 years 1400 - 2000 mls

* Use the child's age only when you do not know the weight. The approximate amount of ORS required (in ml) can also be calculated by multiplying the child's weight (in kg) by 75

Give Zinc

Plan A - Fluid management of NO deydration

Children with diarrhoea but no dehydration should receive extra fluids to prevent dehydration. They should continue to receive an appropriate diet for their age, including continued breastfeeding. Most of these children can be discharged with advice as below:

  1. Give extra Fluid (as much as the child will take)
  2. Zinc Supplements
  3. Continue Feeding
  4. When to Return
  5. Return if the child develops any of the following signs:

Contents of Modified ORS and ReSoMal

Glucose (mmol/L) 75 125
Sodium (mmol/L) 75 45
Potassium (mmol/L) 20 40
Chloride (mmol/L) 65 70
Citrate (mmol/L) 7
Magnesium (mmol/L) 3
Zinc (mmol/L) 0.3
Copper (mmol/L) 0.045