D&V in a child

Risk factors for dehydration

  • Less than 1 year old
  • Not tolerating ORS
  • Stopped breastfeeding
  • More than 6 stools in past 24 hours
  • More than 3 vomits in past 24 hours

 

Data gathering

  • Red flags – blood, drowsiness, not passing urine
  • Others – travel, contacts, feeding
  • Examine
    • temperature, pulse, RR,
    • hydration status – skin, mouth, CRT, fontanelle
    • abdo/chest/CVS

 

Clinical management

  • Explanation
    • Vomiting up to 3 days
    • Diarrhoea up to 10 days
  • Investigations
    • Stool MC&S
      • travel/blood/mucus/immunocompromised
      • not improved after 7 days
    • Ova, cysts, parasites – if travel
  • Treatment
    • Lifestyle
      • Avoid sharing towels, wash hands
      • Continue breastfeeding and fluid intake
      • Avoid fruit juices and fizzy drinks
    • Oral rehydration solution
      • 50ml/kg over 4 hours – often and in small amounts
  • Follow-up / Safety net
    • Drowsy, pale skin, cold extremities, faster breathing, not passing urine
    • Not tolerating ORS
    • Avoid school 48hr from last episode

 

Consider diagnosis other than gastroenteritis in the following

  • Abdominal distension, rebound tenderness
  • Bulging fontantelle
  • Blood/Mucus in stool
  • Bilious (green) vomit
  • Recent head injury
  • Severe abdominal pain
  • Tachypnoea
  • Neck stiffness
  • Temp > 38 (in younger than 3 months)
  • Temp > 39 (in older than 3 months)