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Acute gastroenteritis (peds)
From WikEM
(Redirected from Pediatric acute gastroenteritis)
For adult adult patients see acute gastroenteritis
Contents
Background
- Extremely common childhood illness
- Most commonly viral etiology [1]
- Usually benign in absence of severe dehydration/electrolyte imbalance
Clinical Features
- Diarrhea
- Nausea/vomiting
- Abdominal pain
- Fever, viral symptoms (myalgias, URI symptoms)
Differential Diagnosis
Nausea and vomiting (newborn)
| Newborn | ' |
| Obstructive intestinal anomalies | Esophageal stenosis/atresia, pyloric stenosis, intestinal stenosis/atresia, malrotation ± volvulus, incarcerated hernia, meconium ileus/plug, Hirschsprung disease, imperforate anus, enteric duplications, duodenal atresia |
| Neurologic | Intracranial bleed/mass, hydrocephalus, cerebral edema, kernicterus |
| Renal | Urinary tract infection, obstructive uropathy, renal insufficiency |
| Infectious | Viral illness, gastroenteritis, meningitis, sepsis |
| Metabolic/endocrine | Inborn errors of metabolism (urea cycle, amino/organic acid, carbohydrate), congenital adrenal hyperplasia |
| Miscellaneous | Ileus, gastroesophageal reflux, necrotizing enterocolitis, milk allergy, GI perforation |
Nausea and vomiting infant (<12 mo)
| ' | |
| Obstructive intestinal anomalies | Pyloric stenosis, malrotation ± volvulus, incarcerated hernia, Hirschsprung disease, enteric duplications, intussusception, foreign body, bezoars, Meckel diverticulum |
| Neurologic | Intracranial bleed/mass, hydrocephalus, cerebral edema |
| Renal | Urinary tract infection, obstructive uropathy, renal insufficiency |
| Infectious | Viral illness, acute gastroenteritis, meningitis, sepsis, otitis media, pneumonia, pertussis, hepatitis |
| Metabolic/endocrine | Inborn errors of metabolism, adrenal insufficiency, renal tubular acidosis |
| Miscellaneous | Ileus, gastroesophageal reflux, post-tussive, peritonitis, drug overdose |
Nausea and vomiting child (>12 mo)
| ' | ' |
| Obstructive intestinal anomalies | Malrotation ± volvulus, incarcerated hernia, Hirschsprung disease, intussusception, foreign body, bezoars, Meckel diverticulum, acquired esophageal stricture, peptic ulcer disease, adhesions, superior mesenteric artery syndrome |
| Neurologic | Intracranial bleed/mass, cerebral edema, postconcussive, migraine |
| Renal | Urinary tract infection, obstructive uropathy, renal insufficiency |
| Infectious | Viral illness, gastroenteritis, meningitis, sepsis, otitis media, pneumonia, hepatitis, streptococcal pharyngitis |
| Metabolic/endocrine | Inborn errors of metabolism, adrenal insufficiency, renal tubular acidosis, diabetes mellitus, Reye syndrome, porphyria |
| Miscellaneous | Ileus, gastroesophageal reflux, post-tussive, peritonitis, drug overdose, appendicitis, pancreatitis, gastritis, Crohn disease, pregnancy, psychogenic, cyclic vomiting syndrome |
Evaluation
- Usually clinical
Pediatric signs of dehydration
Significantly dehydrated if has 2 or more of the following (LR+ 6.1, CI:3.8-9.8):[2]
- Prolonged capillary refill (>2 sec)
- Dry mucous membranes
- Absence of tears
- Abnormal overall appearance
Management
Pediatric acute gastroenteritis treatment
- Oral rehydration therapy
- Avoid IV fluids before doing a trial of oral rehydration therapy in uncomplicated cases of mild to moderate dehydration in children.[3]
- If fails, oral ondansetron as a single dose PO (>6 months of age)[4][5]
- If fails, IV fluids (e.g. normal saline)
Disposition
Discharge
- Presumed self-limited etiology
- Well appearing
- Tolerating fluids
Admission and/or Observation
- All others
See Also
External Links
References
- ↑ Pediatric Gastroenteritis in Emergency Medicine. Medscape. http://emedicine.medscape.com/article/801948-overview. Updated Jul 23, 2015. Accessed Jul 24, 2016.
- ↑ Gorelick MH et al. Validity and reliability of clinical signs in the diagnosis of dehydration in children. Pediatrics. 1997; 99(5):E6
- ↑ Choosing wisely ACEP
- ↑ Cheng A. Emergency department use of oral ondansetron for acute gastroenteritis-related vomiting in infants and children. Paediatrics & Child Health. 2011;16(3):177-179.
- ↑ A Cheng; Canadian Paediatric Society, Acute Care Committee. Paediatr Child Health 2011;16(3):177-9
