Office of the DDG: Chief Of Operations

REFERENCE: 16/4

ENQUIRIES: Dr EH Engelbrecht

For Attention:

Chief Executive Officers: Central, Regional and Psychiatric Hospitals

Chief Directors: Metro and Rural District Health Services

District Managers: Metro District Health Services Sub-structures and Rural Districts

Level 2 Heads: General Paediatrics

The Deputy Director: Child Health

Circular: H……../2016

PROTOCOL FOR HOSPITAL WARD LEVEL MANAGEMENT OF GASTROENTERITIS AMONG CHILDREN

This protocol replaces 2014 protocol the standard management of children with acute gastroenteritis with
dehydration who have been admitted to hospital. It complements and is compatible with the acute
gastroenteritis protocols used in Primary Health Care and Emergency Centres. There is a summary document
and a detailed set of protocols and appropriate stationery. A background document, “Protocol for Hospital
Ward Level Management of Gastroenteritis among Children” updating the evidence and the strength of the
recommendations behind this protocol, is available on request and will be placed on the Department’s
website.

The protocol is to be used at all levels of hospital care.

Your co-operation with immediate implementation is appreciated.

DR KEITH CLOETE

DDG: CHIEF OF OPERATIONS

DATE:

23rd Floor, 4 Dorp Street, Cape Town, 8001 P O Box 2060, Cape Town, 8000
tel: +27 21 483 6865 fax: +27 21 483 3277 www.capegateway.go.v.za
 Paediatric Clinical Protocol - Summary

PROTOCOL/GUIDELINE NAME:
GASTROENTERITIS IN CHILDREN: HOSPITAL LEVEL (PART 1)

Date of issue: 01/03/2016

Date for review: 28/02/2017

Main authors: M Kunneke and A Westwood

This management protocol covers emergency and urgent care for acute gastroenteritis in children, and
provides guidelines for ongoing assessment and care of children for the first 48-72 hours of admission.

This protocol’s contents can be adapted for use in specific environments in the province, but the following
essentials of care must be followed:

• Rapid clinical assessment of circulation, hydration and co-morbidities such as severe malnutrition,
pneumonia, sepsis and HIV disease
• Immediate treatment of shock (intravascular dehydration) with pushes of parenteral (intravenous or
intra-osseous) isotonic fluids (normal saline) until the shock is treated or escalation of care is required
• Treatment of extravascular dehydration with Rapid rehydration over four hours by nasogastric
infusion of oral rehydration fluid where possible unless contraindicated
• IV fluid use confined to shocked, severely dehydrated, or complicated cases
• Regular re-assessment of hydration
• Continuing breast-feeding, and early re-introduction of other normal feeds
• Mineral and electrolyte supplementation

What is new in this protocol is

1) While the evidence that clinical criteria can reliably and consistently predict fluid requirements is
poor, distinguishing between degrees of extravascular dehydration would appear still to have value
in indicating how frequently a dehydrated child should be reviewed. In the light of this, degrees of
clinical dehydration categories are retained in this update. However in the light of this classification’s
uncertainty and the South Africa Hospital EML recommendations, a single volume per kilogram body
weight per hour is given for Rapid rehydration for a child with dehydration without shock; this can be
adjusted according to the initial response.
2) A reduced age to 2 months or 60 days of life for the special case of the small infant. This is consistent
with international literature on small babies’ risk profiles.

Paediatric Gastroenteritis Protocol – Urgent and 48-72 hours 1

 Paediatric Clinical Protocol - Summary

Management of Shock (refer to algorithm)

• Use 0.9% normal saline ☻:

Management of other degrees of dehydration (refer to Boxes and Algorithm):

Initial rehydration over four (4) hours (called RAPID REHYDRATION) is indicated in EVERY CASE, EXCEPT in these
situations:

• Shock – requires fluid replacement as fast as possible

• Severe malnutrition – rehydrate over 24 hours (see 10 Steps protocol)
• Cardio-respiratory co-morbidity – rehydrate over 24 hours
• Neurological co-morbidity – rehydrate over 24 hours
• Suspected hypernatraemia – rehydrate over 24 hours
• Small infant under 2 months of age – rehydrate over 24 hours
• Child over 5 years of age – rehydrate over 24 hours

Rapid Rehydration
Oral rehydration solution (e.g. SOROL) NG or ½ Darrow’s Dextrose solution IV:

Dehydration without circulatory shock: All ages and weights: initial rate of 20 ml/kg/hr
Nil by mouth for 4 hours (except if breast feeding)

NB: Re-assess regularly especially if there are marked signs of dehydration. Consider repeating Rapid
Rehydration if still dehydrated at 4 hours.

Slower Rehydration
Oral rehydration solution (e.g. SOROL) NG or ½ Darrow’s Dextrose solution IV:

Dehydration without circulatory shock: All ages and weights: 10 ml/kg/hr (use higher volume if high stool
output).
NB: Re-assess regularly.

Feeding
Never stop breast feeding (unless there is another contraindication). ☻

After the first 4 hours, do not withhold feeds. ☻

Supplements
KCl (in all cases except those with shock)
Vitamin A dose x 1
Zinc for 10 days

Discharge on zinc, instruct parents in danger signs. Sugar salt solution and early follow up for weight check.
Advise an extra meal a day for a week after diarrhoea episode. Use the summary stamp in the Road to
Health Book to alert the PHC system to a child at risk.

Paediatric Gastroenteritis Protocol – Urgent and 48-72 hours 2

 Paediatric Clinical Protocol

Protocol/Guideline Name:
GASTROENTERITIS IN CHILDREN: HOSPITAL LEVEL (PART 1)
Date of issue: 01/03/2016

Date for review: 28/02/2018

Main authors: M Kunneke and A Westwood

Adapted for provincial use from: Protocols designed by General Paediatricians in the Cape Town Metro
District 2006-2011 and Dr M Kunneke in Worcester Regional Hospital and Winelands/Overberg Districts

This management protocol covers emergency and urgent care for acute gastroenteritis in children, and
provides guidelines for ongoing assessment and care of children for the first 48-72 hours of admission. This
covers the period during which most children with gastroenteritis will be discharged from hospital.

This protocol is compatible with the

• Emergency Medicine Gastroenteritis Protocol used in Emergency Centres under the Clinical
Governance of Emergency Medicine
• IMCI and ETAT-SA systems that are often used at PHC sites that may refer patients to hospitals for
ongoing care.
Other protocols in this series cover

• Electrolyte derangements
• Ongoing diarrhoea

The ☻symbol indicates that the evidence for the recommendation is strong (see accompanying Evidence
document).

This protocol’s contents can be adapted for use in specific environments in the province, but the following
essentials of care must be followed:

• Rapid clinical assessment of circulation, hydration and co-morbidities such as severe malnutrition,
pneumonia, sepsis and HIV disease
• Immediate treatment of shock (intravascular dehydration) with pushes of parenteral (intravenous or
intra-osseous) isotonic fluids (normal saline) until the shock is treated or escalation of care is required
(see page 2 – assessment, and page 4 and Appendix 3 – treatment)
• Treatment of extravascular dehydration with Rapid rehydration over four hours by nasogastric infusion of
oral rehydration fluid where possible unless contraindicated (see page 3 – assessment, and pages 5 & 6
– treatment)
• IV fluid use confined to shocked, severely dehydrated, or complicated cases
• Regular re-assessment of hydration (see page 8 - treatment, and Appendix 1 – assessment forms)
• Blood and other tests are usually NOT required (see page 3)
• Continuing breast-feeding, and early re-introduction of other normal feeds (see page 7)
• Mineral and electrolyte supplementation (see page 7)

Paediatric Gastroenteritis Protocol – Urgent and 48-72 hours 1

 GASTROENTERITIS MANAGEMENT PROTOCOL
(PART 1: Urgent Care and the first 48-72 hours)
PAEDIATRICS AND FAMILY MEDICINE

This protocol is designed for use in Level 1 and Level 2 hospitals in areas under the clinical governance of
Family Medicine or Paediatrics.

PREAMBLE:
Most children who are admitted for acute gastroenteritis will be discharged within 48-72 hours having had no
complications. This protocol is designed to cover the period from presentation to discharge in these cases. A
follow-on protocol for cases of ongoing diarrhoea is available at most Level 2 hospitals.

Acute gastroenteritis is one of the commonest reasons for acute presentation in primary care and hospitals. It
is also a leading cause of death, usually from dehydration. Acute gastroenteritis is usually self-limiting with
water loss rapidly diminishing after 48 hours. Careful assessment, fluid therapy and regular re-assessment are
the keys to ensuring good outcomes.

Most importantly, fluid therapy must be initiated early – the longer one waits, the worse the outcome is likely
to be. So, essential history must be obtained while simultaneously assessing vital signs and hydration.

A. History

Essential history must be obtained while simultaneously assessing vital signs and hydration.

• Is the child vomiting; how much?

• When was the last oral intake?
• Stools: blood, mucus, amount, consistency (watery is worst), frequency;
• Diet: malnutrition risk;
• Other systems: especially heart/lung disease (affects decisions re fluids);
• Use of oral rehydration solution;
• Length of history (if > 10 days of loose stools, manage for ‘persistent’ or ‘chronic’ diarrhoea).

B. Examination
a) Assess airway and breathing
b) Always assess for shock next (intravascular dehydration) as it is a leading cause of death from
gastroenteritis:

If the child is shocked, urgent fluids are required. Go to Page 4 and institute therapy immediately

Paediatric Gastroenteritis Protocol – Urgent and 48-72 hours 2

c) If the child is not shocked, check for (extravascular) dehydration:
a. The most objective signs are thirst (eager drinking of ORS) loss of skin turgor and sunken eyes

b. Other signs to look for: sunken fontanelle, dry mucous membranes, lack of tears when crying
The more obvious these signs are the more dehydrated the child is, the more it is essential to initiate
appropriate rehydration measures, and more frequently the child will need review.

d) Assess nutritional status as this will alter fluid volumes to be administered.

e) Calculate the fluid management according to the guidelines below, initiate the fluids and complete the
rest of the clinical examination looking especially for
a. Signs that may suggest electrolyte abnormality (e.g. floppiness, seizures)
b. Signs of severe acute malnutrition, neurological or cardio-respiratory disease that may alter your
fluid prescription.

C. Special investigations
These are NOT routine. ☻

If the child

- Has been shocked

- Has marked signs of dehydration
- Has signs that may suggest electrolyte imbalance (e.g. floppiness, seizures)
- Seems to be sicker than the degree of dehydration would suggest
do the following tests:

- Blood glucose (test strip; serum glucose if test strip is low)

- Urea, sodium, potassium only (creatinine can be ordered later if required – has extra cost)
- Blood gas (there is no point in doing this before resuscitating a shocked child)
- HIV (Rapid) if HIV status is not clearly documented.

Blood culture is indicated in the following circumstances:

- Under 2 months of age

- Shock
- Seems to be sicker than the degree of dehydration would suggest
- High fever
- Severe acute malnutrition

Urine multiple parameter test strip (“dipstix”) is indicated in the following circumstances (remember risk of
false positive test strip result if urine is not fresh)

- Under 2 months of age

Paediatric Gastroenteritis Protocol – Urgent and 48-72 hours 3

- Seems to be sicker than the degree of dehydration would suggest
- High fever
- Malnutrition or growth faltering

Other tests such as Chest X-ray are indicated if co-morbid disease is suspected.
Stool culture only if there is dysentery or suspected diarrhoea outbreak.
Children under 2 months of age with gastroenteritis usually warrant a ‘septic work-up’.

D. Fluid Management (first 4 hours)

Fluid therapy is the mainstay of the management of acute gastroenteritis. ☻

A) Deciding on appropriate fluid regimen:

Take into account
- Degree of dehydration (NB – remember that this is ALWAYS an estimate.)
- Age
- Co-morbid disease (especially severe acute malnutrition)
in working out -
WHAT fluids to give (e.g. isotonic for shock) and -
HOW to give them i.e. route (e.g. nasogastric (NG)), and speed (e.g. Rapid Rehydration).

Shock – this page

Dehydration without circulatory shock – go to page 5

B) Management of Shock (also refer to algorithm – Appendix 3)

- 0.9% normal saline ☻:

o Check glucose test strip (“dextrostix”) and

o Give nasal oxygen, and
o Set up IV line. If unsuccessful after two tries, insert intra-osseous (IO) needle. If < 6 months old or
unsuccessful IO – call senior doctor
o Give 20ml/kg IV or IO by bolus delivered using a 20ml syringe and 3-way tap (NB 10ml/kg if
severely malnourished)
o Check circulation again
o If still shocked, give 10ml/kg until shocked reversed to a maximum of 40ml/kg
(note: if signs of cardiogenic shock develop – enlarging liver, crackles in chest, gallop rhythm –
start inotropes and request help)
o If still shocked or clinically acidotic after 40ml/kg,
 Take blood culture if not already done
 Do acid-base, electrolyte and renal function testing (if possible)
 Give stat dose of IVI Ceftriaxone 100mg/kg
 Start inotropes, AND
 Start another 10ml per kg bolus (unless there are signs of cardiogenic shock), AND
 Call senior doctor who will advise on further use of fluids and inotropes, and other
management of the child.
 Do not leave the child

Paediatric Gastroenteritis Protocol – Urgent and 48-72 hours 4

 (Possible reasons for failure of resuscitation: cardiac disease, hypoglycaemia, sepsis, ARDS, severe
malnutrition, metabolic disease)

When no longer shocked, assess hydration and clinical condition and commence appropriate
continuing hydration regimen (page 5)

C) Dehydration without circulatory shock – initial rehydration:

Initial rehydration over four (4) hours (called RAPID REHYDRATION ☻) is indicated in EVERY CASE,
EXCEPT in these situations:

o Shock – requires fluid replacement as fast as possible

o Severe malnutrition – rehydrate over 24 hours (see 10 Steps protocol)
o Cardio-respiratory co-morbidity – rehydrate over 24 hours
o Neurological co-morbidity – rehydrate over 24 hours
o Suspected hypernatraemia – rehydrate over 24 hours
o Small infant under 2 months of age – rehydrate over 24 hours
o Child over 5 years of age – rehydrate over 24 hours

If no contraindication to Rapid Rehydration, rehydrate according to regimen in Box C1;

If any contraindication to Rapid Rehydration, rehydrate according to regimen in Box C2

BOX C1: Dehydration without circulatory shock BOX C2: Dehydration without circulatory shock
Rapid Rehydration over 4 hours: Rehydration over 24 hours:

(a) ½ Darrow’s Dextrose solution IV or oral
rehydration solution (e.g. SOROL) NG at 20
ml/kg/hour [This volume is based on a
composite of estimated rehydration,
maintenance and ongoing loss
requirements over the first 4 hours.]
(b) Glucose test strip (“dextrostix”)
(c) Blood tests as above (Page 3)
(d) Nil by mouth for four hours unless breast
feeding
(e) Review in two hours (fluid intake,
hydration, blood results) and adjust fluids
accordingly
(f) After 4 hours, re-assess and go to Page 8
NB: If the child is still dehydrated at 4 hours, fluid
losses are likely to have been greater than
previously assessed, so consider repeating the
Rapid Rehydration regimen.
(a) ½ Darrow’s Dextrose solution IV or oral
rehydration solution (e.g. SOROL) NG:
All ages and weights: 10 ml/kg/hr (use a
higher volume if high stool output). [This
volume is based on a composite of
estimated rehydration, maintenance and
ongoing loss requirements over the first 4
hours.]
(NB volumes in severe malnutrition are lower
(refer to 10 Steps Protocol)
(a) Glucose test strip (“dextrostix”)
(b) Blood tests as above (Page 3)
(c) Nil by mouth for four hours unless breast
feeding
(d) Review in two hours (fluid intake, hydration,
blood results) and adjust fluids accordingly
(e) After 4 hours, re-assess and go to Page 8

Paediatric Gastroenteritis Protocol – Urgent and 48-72 hours 5

 E. Diet and Micronutrients

A) Feeding children with gastroenteritis:

Never stop breast feeding (unless there is another contraindication). ☻

After the first 4 hours, do not withhold feeds (Feeding reduces the duration of diarrhoea in most cases).☻

In non-breastfed dehydrated children, feeds must be re-introduced after the first 4 hours of

rehydration.☻

Any child with diarrhoea asking for food or taking oral fluids can be fed.

Small amounts are usually well tolerated.

B) Zinc elemental oral☻

< 1 year of age: 10mg/day/orally

> 1 year of age: 20mg/day/orally

for a total of 10 days (zinc reduces stool output and the chances of a repeat bout in the following three
months)

C) Vitamin A oral
All children who are admitted for gastroenteritis require a dose of Vitamin A:

< 1 year of age: 100000 IU orally stat

> 1 year of age: 200000 IU orally stat

NB: Note this extra dose in the RTHB.

D) Potassium Chloride (KCl) oral

< 6 months of age: 125mg 8hrly orally for 2 days

> 6 months of age: 250mg 8hrly orally for 2 days

NB: Do not give potassium chloride to children who have been shocked until the renal function test results
have been reviewed and it is considered appropriate to supplement potassium intake.

F: Other Problems

A) ELECTROLYTE ABNORMALITIES
- See protocol “Management of Electrolyte Abnormalities in Gastroenteritis”

B) DYSENTERY (Blood in Stool)

- Send stool specimen for culture

- Ciprofloxacin 15mg/kg/per dose 12hrly orally for 3 days.

- Ceftriaxone 50mg/kg/day IVI if toxic, rigors, delirium, leucopaenia, bradycardia or <3 months of age

C) SEVERE MALNUTRITION:
- Admit and treat according to 10 Steps Protocol

Paediatric Gastroenteritis Protocol – Urgent and 48-72 hours 6

 G: Management after the first 4 hours of Rehydration

After the first four hours of rehydration, a full reassessment is required. The following principles apply to
prescribing fluid regimens in this phase:

Regular re-assessment
a) Reassessment of fluid requirements
If the child is still dehydrated, fluid losses are likely to have been greater than previously assessed,
so consider repeating the Rapid Rehydration regimen.

Alternative:

a. Rehydration volume: Reassess hydration as above:

- Still signs of dehydration: 50-100ml/kg above Maintenance Volume spread over 24 hours,
depending on how marked the signs of dehydration are

b. Maintenance volume: in most cases this can all be given as oral feeds (breast or formula)
- 0 – 3month 150ml/kg/d

- 3 – 12 months <10kg 120ml/kg/d

- 10 – 20kg 1000ml + 50ml/kg over 10kg

- > 20kg 1500ml + 20ml/kg over 20kg

Remember: Any child with diarrhoea asking for food or taking oral fluids can be fed.

c. Ongoing losses: 10-15ml/kg for each loose stool or vomit, preferably using oral rehydration
fluid orally. (This volume is a WHO standard.)
b) Do regular reassessments of fluid status and any acute complications

Clinical reassessments are required at least every four hours in the first 24 hours in hospital. Less
frequent assessment is required as diarrhoea and hydration improve. The hydration check form
(Appendix 1) or continuous assessment form (also Appendix 1) can be useful for these assessments.
Wherever possible, reduce IV and nasogastric fluids and increase oral fluids.

- Assess hydration in relation to fluids given

- Assess stool output (consistency, frequency)
- Assess vomiting (amount, frequency, content)
- Assess oral intake (amount, attitude)
- Assess complications and co-morbidities
- Re-write fluid and feed regimens in the light of this information.

Most children do not require repeated blood tests (the kidneys, once perfused well, are very good at
retaining ions and correcting acid-base derangements). [But see “Management of Electrolyte
Abnormalities in Gastroenteritis” for more details.]

Call senior opinion under the following circumstances:

a) Recurrence of shock
b) Marked signs of dehydration: No improvement of hydration status despite high fluid intake

Paediatric Gastroenteritis Protocol – Urgent and 48-72 hours 7

 c) Repeated deterioration in hydration status despite increasing fluid intake
d) Any other deterioration or lack of improvement (e.g. lethargy, respiratory distress)

H: Assessment for Discharge

If the following criteria are fulfilled, the child will usually be ready for discharge:

a) Discharge weight > admission weight

b) Bright eyed and alert
c) Drinking well
d) No vomiting in recent hours
e) Plans for other problems do not require inpatient care

Follow up:
a) Stools resolved: Hygiene advice (prevent another episode). Check SSS knowledge. No follow up
required. Zinc elemental oral (10mg/day <1 years of age, 20mg/day >1 year of age) for 10 days.
b) Stools still not fully formed: refer for weight and hydration check at local clinic. Advice re an extra meal a
day for a week (WHO standard). Stamp RTHB or RHTC with ‘Diarrhoea stamp’ (Appendix 2) and fill in any
necessary details, or write a short note including discharge weight and complications. Check SSS
knowledge. Zinc elemental oral (10mg/day <1 years of age, 20mg/day >1 year of age) for 10 days.
c) Other problems present: follow up in Primary Care service (e.g. nutrition clinic, local authority clinic)
unless specific hospital-level service is required (remember the cost of transport to the family).
d) Advise an extra meal a day for a week for every child after an episode of gastroenteritis to assist with
regaining list weight.
NB. Always ensure that the parent/caregiver

- knows how to make home-made oral rehydration solution safely

- understands danger signs and where to access care
- is reminded/taught the essentials of hand hygiene and safe food preparation.

I: Ongoing Dehydrating Diarrhoea

If after 48-72 hours of admission (2 full nights) there is no clear improvement, further testing and feed
manipulation may be required for possible lactose intolerance or systemic disease.

Use the protocol for ongoing diarrhoea and get senior advice.

Paediatric Gastroenteritis Protocol – Urgent and 48-72 hours 8

 APPENDIX 1: Forms for Continuous Assessment of Hydration

HYDRATION CHECK

Weight g ↑ ↓

Vomiting Y N

Stools

Input Maintenance

Rehydration

OL

Intravascular status

LOC ↓ Normal

Peripheries Cool Warm

CRT Prolonged Normal

Pulses Weak Strong

Tachycardia Present Absent

Assessment Shocked Not shocked

Extravascular status

Mucous Dry Moist

membranes

Eyes sunken Yes No

Fontanelle Sunken Normal

Skin turgor Abnormal Normal

Assessment 10% 5 % dry Well

dry hydrated

Plan

Paste into the clinical record in appropriate place.

Paediatric Gastroenteritis Protocol – Urgent and 48-72 hours 9

REHYDRATION: CONTINUING ASSESSMENT (after rapid rehydration)

DATE / DAY: ______________________________

TIME : AM / PM : : AM / PM : : AM / PM :

WEIGHT

TEMPERATURE

VOMITING

STOOLS

DRINKING ORS NOT / FAIR / WELL NOT / FAIR / WELL NOT / FAIR / WELL

DRINKING MILK / EATING NOT / FAIR / WELL NOT / FAIR / WELL NOT / FAIR / WELL

CIRCULATION/PULSE RATE / / /

DEHYDRATION NONE / PRESENT / MARKED NONE / PRESENT / MARKED NONE / PRESENT / MARKED

ORAL FEEDS (milk/meals)

ORS (per hour or per stool)

DRIP VOLUME per hour

Paediatric Gastroenteritis Protocol – Urgent and 48-72 hours 10

 APPENDIX 2: Template for Diarrhoea Stamp for RTHB

CHILD AT RISK: PLEASE REVIEW REGULARLY

This child was admitted to

__________________ Hospital

On __/___/___ with _____________,

and discharged on ___/____/___.

Discharge weight: _______ kg

Complications: ____________________________

_____________________________

Monitor weight, extra feeds for a week,

refer back if concerned.

Paediatric Gastroenteritis Protocol – Urgent and 48-72 hours 11

 APPENDIX 3: Shock Management Algorithm

Paediatric Gastroenteritis Protocol – Urgent and 48-72 hours 12

 APPENDIX 4: Dehydration Management Algorithm

Paediatric Gastroenteritis Protocol – Urgent and 48-72 hours 13

 APPENDIX 5: Consumables required for Rehydration of Children with
Gastroenteritis in Hospitals

Equipment:

1) Shock:

a. Blood glucose test strips or Glucometer

b. Size 21 intravenous cannulae

c. 18 gauge Intraosseous needles

d. IV giving sets

e. IV in-line or other infusion controller

f. Oxygen tubing and nasal catheter of prongs

2) Intravenous rehydration

a. Size 21 intravenous cannulae

b. IV giving sets

c. IV in-line or other controller

3) Naso-gastric rehydration

a. Size 8 NG tubes

b. Drip feeding sets (Applix, Fresenius)

c. 200ml or 250 ml feeding bottles and hangers

d. Enteral infusion pumps (in larger hospitals)

Infusion controller machines for IV or enteral feeds are optional as in-line controllers can be used with the IV
giving sets for IV rehydration, or the Applix tubing for NG rehydration (Set up drip with ORS (Sorol) 200ml,
Applix Fresenius giving set, IV in-line controller (put in backwards) and attached to NG tube with the Fresenius
connector).

Pharmaceuticals:

1) Oral rehydration solution

2) Normal saline 200ml vacolitres

3) ½ Darrow’s Dextrose 200ml vacolitres

4) Dextrose solution for intravenous use

5) Ceftriaxone IVI injection

6) Zinc elemental miscible tablets

7) Potassium chloride oral solution

8) Vitamin A capsules

Paediatric Gastroenteritis Protocol – Urgent and 48-72 hours 14