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.

Supportive Therapy

Oral Rehydration Solution (ORS)

  • The formula recommended by the World Health Organization (WHO)
    • Concentration of: 75 mEq/L sodium, 75 mmol/L glucose w/ total osmolarity of 245 mOsm/L
    • Lower osmolarity that is proportionally reduced sodium & glucose concentrations
    • The formulation has been shown to reduce vomiting & the need for intravenous (IV) fluids
  • As effective as IV fluids in rehydrating patients with mild to moderate dehydration
  • Severe vomiting, abdominal ileus & in state of hemodynamic shock are contraindications to oral rehydration solution

Intravenous (IV) Fluids or Nasogastric (NG) Oral Rehydration Solution (ORS)

  • Given for 4-6 hours or until adequate hydration is achieved
  • Recommended in the following patients:
    • Severely dehydrated
    • In whom oral hydration has failed due to severe vomiting
    • Patients with intestinal ileus or intestinal obstruction
  • Nasogastric feeding allows continuous oral rehydration solution administration at a slow & steady amount

Minimal or No Dehydration

  • Replace fluid losses by giving 60-120 mL of oral rehydration solution for each diarrheal stool or vomiting episode in patients who weigh <10 kg
  • For a patient with body weight of >10 kg, administer 120-240 mL of oral rehydration solution for each episode of fluid loss
  • Continue breastfeeding or resume age-appropriate feeding

Mild to Moderate Dehydration

  • Administer 50-100 mL of ORS/kg body weight over 3-4 hours to replace estimated fluid deficit
  • Give additional oral rehydration solution to restore ongoing fluid loss; may use the recommended amount as with minimal dehydration
  • Several trials support the use of nasogastric oral rehydration solution feeding even in patients with continuous vomiting or with presence of oral ulcers
  • Rapid IV hydration may also be administered

Severe Dehydration

  • Start patient on rapid IV rehydration
  • Administer 20 mL/kg body weight of IV lactated Ringer’s solution or normal saline solution (0.9% NaCl) until pulse, perfusion & mental status return to normal, followed by 100 mL/kg body weight of oral rehydraiton solution for 4 hours or 5% dextrose ½ normal saline IV at 2x maintenance fluid rates
    • Alternatively, give 100 mL/kg body weight. Then, for infants <1 year give 30 mL/kg/body weight within the 1st hour, followed by 70 mL/kg/body weight within 5 hours. For children >1 year, 30 mL/kg/body weight IV fluid may be given within the 1st 30 minutes, followed by 70 mL/kg/body weight within 2.5 hours
    • Administration of oral rehydration solution (ORS) may encourage early resumption of feeding
    • Study shows that giving of oral rehydration solution (ORS) may lead to rapid resolution of acidosis compared to IV fluid
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