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This document provides information on the causes, treatments, and management of acute gastroenteritis. It lists common causes like cholera, rotavirus, salmonella, and shigella. It also outlines rehydration protocols for mild, moderate, and severe dehydration in infants and children. The document discusses intravenous fluid selection and electrolyte abnormalities including hyponatremia, hypernatremia, hypokalemia, and hyperkalemia. It provides dosing guidelines for correcting electrolyte imbalances. Lastly, it lists pharmacological treatments for vomiting from different causes like chemotherapy, surgery, and intestinal pseudoobstruction.

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Johanisa Benito ALawi-Rakiin
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105 views26 pages

Age PDF

This document provides information on the causes, treatments, and management of acute gastroenteritis. It lists common causes like cholera, rotavirus, salmonella, and shigella. It also outlines rehydration protocols for mild, moderate, and severe dehydration in infants and children. The document discusses intravenous fluid selection and electrolyte abnormalities including hyponatremia, hypernatremia, hypokalemia, and hyperkalemia. It provides dosing guidelines for correcting electrolyte imbalances. Lastly, it lists pharmacological treatments for vomiting from different causes like chemotherapy, surgery, and intestinal pseudoobstruction.

Uploaded by

Johanisa Benito ALawi-Rakiin
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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ACUTE

GASTROENTERITIS
SUD
Cause Treatment
Cholera Rehydration; Single dose Doxycycline
Rotavirus (stools -free of blood and leukocytes) Hydration; Lactobacillus
Salmonella gastroenteritis Cefotaxime, Ceftriaxone, Ampicillin,
Cefixime
Shigella (Bacillary dysentery) Ciprofloxacin
•  Dysentery: bloody diarrhea with fever, abdl
cramps, rectal pain and mucoid cells
Enterotoxigenic E. coli Hydration
Shiga-toxin/ Enterohemorrhagic E. coli Hydration
Enteroinvasive E. coli TMP-SMX
Campylobacter Eryhtromycin or Azithromycin
Yersinia enterocolitica TMP-SMX
Amebiasis / Entamoeba histolytica Metronidazole then Diloxanide furoate
Holiday- Segar Method
Water per 24 hours
Body Weight mL/kg/day ml/kg/hr
First 10kg x 100 4
Second 10kg x 50 2
Each additional kg x 20 1
Fluids
1.  Maintenance
2.  Deficit
3.  Replacement

*Don’t forget to always order replacement for losses.


DEFICIT THERAPY
INFANT OLDER
CHILD
MILD <5% <3% Normal or increased pulse Thirsty
Decreased UO Normal PE

MOD 5-10% 3-6% Tachycardia Dry mucous membranes


Little or no UO Mild delay in elasticity (skin
Irritable/lethargic turgor)
Sunken eyes and fontanel Delayed capillary refill (> 1.5
Decreased tears sec)
Cool and pale

SEVERE >10% >6% Rapid, weak or absent Parched mucous membranes


peripheral pulses Very delayed CRT (>3)
Decreased BP Cold and mottled, limp
No UO Depressed consciousness
Very sunken eyes and fontanel
NELSONS
Ludan’s Method
Mild DHN Moderate Severe
<15kg 50cc/kg 100 150
< 2y/o
> 15kg 30 60 90
> 2 y/o
¼ in 1 hour 1/3 in 1 hour
¾ in next 7 2/3 in next 7
hours hours
Consensus statements
Mild Moderate Severe
3-5% deficit 6-10% 9-15%
Infant 50 ml/kg 100 ml/kg 150 ml/kg
Child/Adol 30 ml/kg 60ml/kg 90 ml/kg
¨  Administer 50% deficit in the first 8 hours then the
remaining volume in the next 16 hours
1st 8 hours 50% deficit + 1/3 of maintenance
2nd 8 hours 50% deficit + 2/3 of maintenance
3rd 8 hours
WHO – SOME signs of DHN
Age <4 mo 4-11 mo 12-23 mo 2-4 yrs 5-14 yrs >15 yrs
Wt (kg) < 5 5-7.9 8-10.9 11-15.9 16-29.9 >30
in mL 200-400 400-600 600-800 800-1200 1200-2200 2200-4000

¨  Approximate ORS (mL) = wt (kg) x 75


WHO – SEVERE signs of DHN
100 ml/kg/hr < 12 mo Older
First 30 ml/kg 1 hour 30 mins
Then 70 ml/kg 5 hours 2 ½ hours

¨  Reassess hydration every 1-2 hours


IV fluids
Na (meq/ K Cl HCO3 Mg (mg/ Ca (mg/
L) dl) dl)
pLR 130 4 109 28 - 3
lactate
pNSS 154 - 154 - - -
D5 0.3 51 - 51 - - -
NaCl
D5IMB 25 20 22 - 3 -
D5NR 140 5 98 27 - -
acetate
D5NM 40 13 40 16 3
acetate
Selection of Maintenance Fluids
¨  NPO
¤  1 L D5 ½ NS + 20 meqs KCl
n  Recommended in the child who is NPO and does not have
volume depletion or risk factors for nonosmotic ADH
production
¨  Surgical patients
¤  Isotonic
fluid (NS, LR) during surgery and in the
recovery room for 6-8 hours postop
¤  Subsequent: D5NS or LR with addition of 10-20 meqs
KCl
Replacement fluid for Diarrhea
¨  High bicarb concentration in stool
¨  1 L D5 ½ NS + 30 meqs NaHCO3 + 20 Meqs/L
KCl
¨  Replace stool ml/ml every 1-6 hours

¨  Formula for D5 ½ NS or D5 0.45NaCl:


¤  Half vol D5NSS + half D5 water
¤  1 L D50.3 NaCl + 25 meqs NaCl

NELSONS
Replacement Fluid for emesis or NG losses

¨  Loss of potassium
¨  1 L NS + 10 meqs KCl

¨  Replace output ml/ml every 1-6 hours

NELSONS
Decreased or Increased UO
¨  Oliguria/anuria
¤  25-40% of maintenance as replacement for insensible losses
with D5 ½ NS
¤  Replace UO ml/ml with D5NS +/- KCl

¨  Polyuria
¤  25-40% of maintenance as replacement for insensible losses
with D5 ½ NS +/- KCl
¤  Measure urine electrolytes
¤  Replace UO ml/ml with solution based on measured urine
electrolytes
NELSONS
Electrolytes

Electrolyte Daily requirement (meqs/kg/day)


Na 2.5-3.0
K+ 2-2.5
Hyponatremia < 135 meqs/L
¤  Maintenance: 3 meqs/kg/day
¤  Deficit: (Desired Na – actual Na) x 0.6 x weight
¤  Total Na required: M+D – bolus
¤  Correction: not more than 12meqs/L/24hr or >18meq/L/
48hr

¤  Fast
correction: 4 ml/kg/dose of 3% NaCl
¤  3% NaCl = 1 ml 2meqs/ml NaCl + 4 ml sterile water
¨  Brain swelling - hyponatremia
¨  Rapid correction of hyponat -> Central pontine
myelinolysis (CPM)
Hyponatremia - example
¨  Serum Na 125, wt 12kg

¨  Maintenance: 3 x 12 kg = 36 meqs
¨  Deficit: (135-125) x 0.6 x 12 kg = 72 meqs
¤  Why 135 as desired? Remember: not more than 12meqs/L/
24hr (I use 10meqs difference between desired and actual
para safe)
¤  Why 0.6? Total body water is 60% of body weight
¨  Total Na required: M + D = 36 + 72 = 108 meqs
HyperNatremia >145 meqs/L
¤  Totalwater required for 2 days = M for 2 days + D
¤  Ideal TBW (liters): weight x 0.6
¤  Actual TBW = ideal TBW x ideal serum Na/actual Na

¤  Water deficit: ideal TBW – actual TBW

¨  Untreated Hypernatremia -> Brain Hemorrhage


HypoKalemia
¨  Fast correction: 0.5-1 meqs/kg/dose in PNSS diluent to
run for 1 hour (0.5 meqs/kg/hr) x 3-5 doses (max: 40)
¤  Max peripheral line: 40 meqs/L
¤  Max central line: 150-200 meqs/L

¨  Oral: 1-4 meqs/kg/24 hr BID- QID


¤  Kaliumdurule = 10 meqsK/ durule
¤  Oral KCl 10% soln = 1.34 meqs/ ml

Harriet Lane
HypoKalemia
¨  PO correction
¤  Oral KCl 10% of 4-6 meqs/kg/day in divided doses
¨  Parenteral
¤  Intermittent dosing (symptomatic): 0.5 to 1 meqs/kg/hr
with max infusion rate of 0.5 meqs/kg/hr given q2-4
hours until sxs resolve
¤  Continuous (nonsymptomatic): 0.2-0.3 meqs/kg/hr for
24 hours
Bedside Pediatric Nephrology
Hypokalemia - example
¨  We use 3-4 meqsK/kg/day for correction
¨  Example: wt 6 kg, K 2.0, will choose/deliver 3.5

meqsK/kg/day as correction
¤  3.5 x 6 kg = 21 meqs/day
¨  PO
¤  OralKCl 10% (1.34meqsK/ml): 21 meqs/1.34meqs =
15.6 ml divided in 3 doses = ~5ml tid x 3 doses only

PGH
Hypokalemia - example
¨  IV
¤  3.5x 6 kg = 21 meqs/day
¤  Maintenance fluid: 600 ml/day at 25 cc/hr

x = 35 meqs
21 Order: 1 Liter D5NSS + 35 meqs KCl at
x
meqs 25 cc/hr
(delivering 3.5 meqs K /kg/day) to run
600 1000 for 24 hours ONLY
ml ml Measure serum K after correction
PGH
HyperKalemia
HyperKalemia
Pharmacotherapies for Vomiting
DRUG DOSE
Reflux Metoclopramide 0.1-0.2 mg/kg PO or IV qid

Gastroparesis Metoclopramide 0.1-0.2 mg/kg PO or IV qid


Erythromycin 3-5 mg/kg PO or IV tid-qid
Chemotherapy Metoclopramide 0.5-1mg/kg IV qid
Ondansetron 0.15-0.3 mg/kg IV or PO tid
Postoperative Ondansetron 0.15-0.3 mg/kg IV or PO tid

Intestinal Octreotride 1 ug/kg SC bid-tid


Pseudoobstruction

Nelsons

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