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
- Rehydration phase: Electrolytes & water are administered as oral rehydration solution (ORS) to replenish fluid losses
- 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