Acute Gastroenteritis in Children

Clinical Description

• Passage of more than 3 loose stools in a day.

Causes

• Infection: majority are caused by viruses, bacteria, parasites, Toxins, Drugs

Malabsorption: e.g. lactose intolerance and Food Protein Induced Entero-Colitis

Syndrome (FPIES).

Signs and Symptoms

• Shock
• Vomiting
• Diarrhoea
• Failure to thrive
• Abdominal pain

Investigations

• Stool microscopy and culture
• Random blood glucose
• Blood gas
• Urea, electrolytes, and Creatinine
• FBC

Treatment

• Assess nutritional status. If malnourished, refer to malnutrition protocol
• Assess dehydration and treat accordingly

Classification Signs and Symptoms Treatment

Severe Dehydration Two or more of the following signs:

Lethargy/unconsciousness

Sunken Eyes

Unable to drink/drinks poorly

Skin pinch goes back very slowly (≥2seconds)

PLAN C

Some Dehydration Two or more of the following signs:

Restlessness/irritability

Sunken eyes

Drinks eagerly/thirsty

Skin pinch goes back slowly

PLAN B

No Dehydration Not enough signs to classify as some or severe dehydration

PLAN A

• Plan C: see severe dehydration protocol
• Plan B: give 75ml/kg ORS over 4 hours
• Plan A give ORS 5ml/kg after each loose stool.
• Continue breastfeeding or give extra fluid.
• Correct electrolyte imbalances.
• Zinc 10mg PO 24 hourly < 6 months and 20mg if > 6months old for 10 days.
• ONLY give antibiotics if bloody diarrhoea or if child is toxic.
• Ciprofloxacin 10mg/kg PO 12 hourly for 5-7 days or Ceftriaxone 25 mg -50mg/kg IV 24 hourly for 5 days if not tolerating orally.

DO NOT give antiemetic’s or anti-motility drugs in children.

Complications

• Acute Kidney injury
• Electrolyte imbalance
• Haemolytic Uraemic Syndrome (HUS)

Complications and Referral Criteria

Persistent diarrhea not responding to treatment