Episode 941: Rehydration in Pediatric Gastroenteritis

Contributor: Meghan Hurley, MD

Educational Pearls:

• Gastroenteritis clinical diagnoses:

• Diarrhea with or without vomiting and fever

• Vomiting in the absence of diarrhea has a large list of differential diagnoses, so the combination of diarrhea and vomiting in a patient is helpful to indicate the gastroenteritis diagnosis

• Symptom timeline is usually 1-3 days, but can last up to 14 days – diarrhea persists the longest

• Treatment for mild to moderate dehydration: oral or IV rehydration

• Begin orally to avoid unnecessary IV in a pediatric patient

1. Administer ODT Ondansetron (Zofran) to prevent vomiting

   1. Meta-analysis showed that 2-8 mg orally, based on body weight, decreased vomiting quickly

2. Wait 15-20 minutes for the medication to take effect

3. Use streamlined method for oral rehydration: Fluids such as over-the-counter Pedialyte, Infalyte, Rehydrate, Resol, and Naturalyte may be used

   1. If patient weighs less than 10kg: administer 5mL of fluid per minute for 20 minutes

   2. If patient weighs 10kg or more: administer 10mL of fluid for 20 minutes

4. If the patient can keep the fluid down, double the fluid volume and repeat

5. If the patient once again keeps the fluid down, double the fluid volume and repeat

• If successful with each attempt, the patient may be discharged home

• Can prescribe ODT Zofran for 1-2 days at home

• If the patient vomits more than once during this oral rehydration process, intravenous rehydration must be initiated

References

1. Churgay CA, Aftab Z. Gastroenteritis in children: Part II. Prevention and management. Am Fam Physician. 2012 Jun 1;85(11):1066-70. PMID: 22962878.

Summarized by Meg Joyce, MS1 | Edited by Meg Joyce & Jorge Chalit, OMS3

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