gastroenteritis%20-%20viral
GASTROENTERITIS - VIRAL
Acute gastroenteritis is a diarrheal disease of rapid onset.
Viruses are one of the common causes of gastroenteritis.
Rotavirus, enteric adenovirus serotypes 40 & 41, astrovirus and calicivirus (eg "Norwalk-like" virus) are the established viral agents causing gastroenteritis.
Rotavirus is the most common pathogen causing diarrhea in patients 3-24 months old.
Patients <3 months old are protected by maternal rotavirus antibodies that are passed transplacentally and possibly by breastfeeding.
Transmission is through fecal-oral route.
Incubation period may vary from 1-10 days depending on the causative agent.

Principles of Therapy

  • 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

Pharmacotherapy

  • 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

Non-Pharmacological Therapy

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

Indications of Hospital Admission

  • 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
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