A Synopsis of AFP's "Gastroenteritis in Children: Part II. Prevention and Management"

Gastroenteritis in Children: Part II. Prevention and Management
CATHERINE A. CHURGAY, MD, Hope Medical Clinic, Ypsilanti, Michigan, ZAHRA AFTAB, MD, St. Luke’s Hospital/University of Toledo, Maumee, Ohio
Am Fam Physician. 2012 Jun 1;85(11):1066-1070.
http://www.aafp.org/afp/2012/0601/p1066.pdf

     The most important part of gastroenteritis treatment is dehydration prevention.  First line therapy is oral rehydration therapy (ORT). The composition of the solution is:
     50 mEq/L Na,
     25 g/L dextrose, and
     30 mEq/L bicarbonate.
Fluids such as water, apple juice, watered down formula, soda, or chicken broth, are not recommended because they are hyperosmolar and do not contain proper electrolyte replacement. Recommended solutions include Pedialyte, Rehydrate, Infalyte, and Naturalyte.
     In mild to moderate dehydration, patients should be given 50 ml per kg of ORT. This can be done at home by giving the patient 1 ml of solution per kg every five minutes for three to four hours. Take a short break if the patient vomits. An additional 10 ml per kg should be added for each loose stool or vomiting episode.  
     In moderate to severe dehydration, hospital admission may be required, especially if the patient is having intractable vomiting, profuse diarrhea, not getting adequate oral hydration, or not getting better after 24 hours.  In this case, infants should get 30 ml per hour ORT, toddlers should get 60 ml per hour, and older children should get 90 ml per hour. 10 ml/kg can be added for each loose stool or vomiting episode. Ondansetron has been helpful in vomiting patients.  If IV fluids are required, NS or RL can be used. A bolus of 10-20 ml/kg should be given first, followed by a maintenance fluid.  Maintenance fluids are based on weight:
     100 ml/kg for the first 10 kg
     50 ml/kg for the next 10 kg
     20 ml/kg for the next 10 kg
Regular diet can be continued once patient is adequately hydrated. Probiotics have shown promise in reducing the effects of gastroenteritis. They work by degrading and modifying the dietary antigens. They also regulate the inflammatory effects of cytokines. They do not colonize the gut flora, but leave the system within 1-2 hours. Antidiarrheals, such as loperamide should not be used and may increase nausea and constipation. Handwashing is very beneficial in preventing disease spread. Antibacterial soap is not better than regular soap.
     Rotavirus vaccine has made a big impact on the prevalence of the infection. It is a live, oral vaccine given at two, four, and six months after birth and thus discontinued.  The current vaccine is recommended and safe, although some studies note a small increase of intussusception with Rotateq as well.