Basics of gastroenteritis in the paediatric ED: Rehydration

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Key points:
• In mild or moderate dehydration, oral or NG rehydration is as effective as IV hydration and is better tolerated by patients and parents.
• Aim for 10mls/kg/hour of oral or NG rehydration
• Breastfed babies should continue to be breastfed.
• Apple juice mixed 1:1 with water has also been shown to be better tolerated and equally effective as hydralyte in cases of mild dehydration.
• Enteral rehydration is successful about 96% of the time
• The remaining 4%, and anyone with severe dehydration, needs IV hydration.
• Use ondansetron over the age of 6 months to alleviate vomiting.
• If IV hydration required, discuss with paeds/senior regarding the appropriate rate.

References:

Colletti JE, Brown KM, Sharieff GQ, Barata IA, Ishimine P. The Management of Children with Gastroenteritis and Dehydration in the Emergency Department. J Emerg Med [Internet]. 2010;38(5):686–98. Available from: https://dx.doi.org/10.1016/j.jemermed...

Fedorowicz Z, Jagannath V, Carter B. Antiemetics for reducing vomiting related to acute gastroenteritis in children and adolescents. [Internet]. Cochrane database of systematic reviews. 2011. Available from: https://www.cochranelibrary.com/cdsr/...

Freedman SB, Willan AR, Boutis K, Schuh S. Effect of Dilute Apple Juice and Preferred Fluids vs Electrolyte Maintenance Solution on Treatment Failure Among Children With Mild Gastroenteritis: A Randomized Clinical Trial. JAMA. Published online April 30, 2016. doi:10.1001/jama.2016.5352

Angharad Griffiths . Gastroenteritis, Don't Forget the Bubbles, 2020. Available at: https://doi.org/10.31440/DFTB.28790

Hartling L, Bellemare S, Wiebe N, Russell KF, Klassen TP, Craig WR. Oral versus intravenous rehydration for treating dehydration due to gastroenteritis in children. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004390. DOI: 10.1002/14651858.CD004390.pub2. Accessed 25 July 2022.

https://www.rch.org.au/clinicalguide/...

NICE. Management of vomiting omiting in children and young people with gastroenteritis : ondansetron. NICE GUIDELINES. 2014. p. 1–20.