• Viral gastroenteritis is generally a self-limiting illness
• Treatment is based on the degree of dehydration
• Oral replacement therapy (ORT) encompasses 2 phases of treatment: 
  • Rehydration phase: Electrolytes & water are administered as oral rehydration solution (ORS) to replenish fluid losses
    • Should be performed rapidly within 3-4 hours
  • Maintenance phase: Restoration of ongoing fluid & electrolyte losses, & adequate dietary intake
• Age-appropriate diet (including solids) for rapid realimentation is recommended once adequate degree of hydration is attained
• Breastfeeding should be continued especially for breastfed patients
• Changes in formula milk are not necessary

• No specific antiviral therapy is available
• Based on several controlled studies, antidiarrheal medications have shown no benefit in patients with viral gastroenteritis
• Studies have shown that antiemetic agents (eg Ondansetron) may be used to decrease vomiting or help avoid the need for intravenous fluid, but may increase episodes of diarrhea
• Zinc supplementation given during an episode of diarrhea may decrease the duration & severity of diarrheal illness, & reduce the incidence of diarrhea in the next 2-3 months
  
  • For patients up to 6 months, may give 10 mg/day PO x 10-14 days
  • Patients ≥6 months, may give 20 mg/day PO x 10-14 days
• Probiotics have been shown to reduce the intensity & duration of diarrhea
  • May be used in rotavirus gastroenteritis
  • Examples include Lactobacillus sp, Saccharomyces boulardii, Bifidobacterium sp

Dietary Therapy

• Depends on age & diet history
• Breastfed patients should continue nursing on demand while formula-fed patients must continue their usual full-strength milk
  • Based on several trials, feedings w/ diluted formula is associated with protracted symptoms & delayed nutritional recovery
• Lactose-free formulas are recommended in patients with documented & persistent lactose intolerance
• Intake of patient’s usual diet is recommended
• Recommended foods include complex carbohydrates, meats, yogurt, fruits & vegetables
  • Highly specific diets [eg BRAT (banana, rice, applesauce & toast) diet] have been commonly recommended, however these may provide insufficient nutrition for patient’s nourishment & recovering gut
• Foods high in simple sugars should be avoided

• Severely dehydrated
• Difficulties in oral rehydration therapy (ORT) administration [eg continuous vomiting, refusal or inadequate intake of oral rehydration solution (ORS)]
• Failure of oral rehydration solution treatment including worsening diarrhea or dehydration despite adequate volumes
• Presence of coexisting illnesses
• Family incapable of providing adequate care at home
• Concerns that might prevent return for evaluation or follow-up
• Presence of the following factors: Young age, changes in sensorium, advancing course of symptoms, need for close monitoring due to ambiguous diagnosis