D&V in kids

Paediatric gastroenteritis can be a pain for everyone but as with most of EM – Keep It Simple

  • Not dehydrated – make sure they can tolerate fluids, and encourage hydration, think about ORT
  • Dehydrated – look for the red flags that indicate they are developing shock. Use ORT unless IV indicated
  • Shocked – you will need access and it will probably be difficult (IO on awake children really isn’t that bad)

Severity

  • Look for signs of dehydration & shock
  • Red fields indicate increased risk of developing shock
  • Signs of hypernatremia
    • Jittery
    • Increased muscle tone
    • Hyperreflexia
    • Convulsions
    • Drowsy/coma

Differentials

  • Gastroenteritis/Food poisoning
  • Systemic Infection [UTI, Pneumonia, Sepsis]
  • Surgical [Appendicitis, intussusception, Bowel Obstruction, Mal-rotation]
  • Medical [DKA, HUS, Congenital adrenal hyperplasia, raised ICP]

Prevent Dehydration

  • Continue breastfeed/milk
  • Encourage fluid Intake
  • Discourage fruit juice or Soda
  • Offer Oral rehydration therapy

Treating dehydration

Use Oral Rehydration Therapy unless IV fluid indicate

  • 50ml/kg over 4 hours
    • Frequent small volumes
    • Consider supplementing
    • with usual fluids
    • Consider giving via NG (if cant unable to drink)
    • Consider admission to Paediatrics

IV Therapy

  • Shock or suspected shock
  • Red flags/fields
  • Not tolerating ORT

Get Senior Support

Shock/Suspected Shock – 20ml/kg, 0.9% NaCl

Rehydration strategies

  • 0.9% NaCl +/- 5% glucose
    • Shocked (10% dehydrated)
      • Add 100ml/kg to maintenance
    • Not Shocked (5% dehydrated)
      • Add 50ml/kg to maintenance
    • Not Shocked [hypernatremia]
      • Replace deficit over 48 hours

Maintenance fluid – based on total weight

  • 0-12.9kg – 80ml/kg/24hr
  • 13-19.9kg – 65ml/kg/24hr
  • 20-34.9kg – 55ml/kg/24hr
  • 35-59.9kg – 45ml/kg/24hr
  • >60kg – 35ml/kg/24hr
 PDF:dvp

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