Acute gastroenteritis in pediatric

Most: Viral cause AGE

ถ้ามี bilious or bloody vomitus, hematochezia, abdominal pain ทำให้คิดถึง bacterial หรือ surgical condition

Ddx

• Appendicitis: abdominal pain followed by vomiting (asso. constipation), diarrhea (frequent, full of mucus, small in volume) if perforate or irritate the colon
• Prolapse gastropathy: small amounts of self-limited, blood-tinged, or coffee ground emesis
• Bloody diarrhea + known outbreak of HUS or positive c/s for E.coli O157:H7: r/o renal failure, thrombocytopenia, hemolytic anemia

Accessing dehydration

• Hx of fluid intake, urine output
• % of body weight loss 

Signs to be Evaluated during Hydration Assessments

Investigation

• Stool exam : Moderate sensitivity: WBC > 5/HF
• Stool culture if >10 stools/24 hrs, travel to high risk country, fever, older age, blood or mucus in stool, abdominal pain, persistent diarrhea
• BS, electrolyte if Mod dehydrated children inconsistent with AGE 
•  All severely dehydrated children
•  All children requiring IV rehydration, or those with potential hyper- or hyponatremia
• Imaging (plain film, CT, US) if suspected abdominal surgery, FB ingestion, abnormal BS, abdominal distention, peritoneal signs

Treatment

• ORS by PO/ NG Start 5 ml q 2-5 min aim for 30 ml/kg/hrs reassess q 1 hr 
• Ondansetron 0.15 mg/kg IV/IM Give if N/V, wait 15 min before resuming ORS
• Continue age-appropiate diet: Do not withhold feeding > 4 hrs; Most young children can continue to receive lactose-containing milk
• Zinc 
• Adsorbents/antisecretory agents/probiotic : limited data
• Antibiotic
• Azithromycin(DOC) 10 mg/kg/d x 3d
• Ceftriaxone
• Ciprofloxacin : Symptom of invasive infection: acute bloody diarrhea with mucus and high fever or expose to cholera
• IV ATB if toxic appearance or U/D immunodeficiency, and febrile infants <3 mo of age