Acute Gastroenteritis

Sadesvaran Muniandy
 Introduction
• An illness characterized by diarrhoea and
abdominal discomfort, which may be
accompanied by nausea and/or vomiting.
• Caused by ingestion of bacteria or virus or their
toxins from contaminated food/water.
• Self limiting.
• Acute diarrhea, sometimes with vomiting is the
predominant symptoms of infective
gastroenteritis.
 History
• Diarrhea • Vomiting
– Duration? – Duration?
– Amount? – Amount?
– Frequency? – Frequency?
– Associated wit
abdominal pain? • Other history
– Bloody diarrhea? • Last meal?
• Any family/friends with
similar symptoms?
• Antibiotic use?
 Examination
• Vital Sign
– Pulse
– BP
– Temperature
– Respiratiory Rate
• Dehydration status
• Abdominal examination
 Assessment of dehydration status
Mild (3-5%) Moderate (7-10%) Severe (10-15%)
• Tachycardia • Rapid, weak pulse
• Normal or • Little or no urine
increase pulse • Decreased blood
output pressure
• Decreased • Irritable/Lethargic • No urine output
urine output • Sunken eyes • Very sunken eyes
• Decreased tears • No tears
• Thirsty • Dry mucous • Parched mucous
• Normal membranes membrane
physical exam • Skin tenting
• Skin tenting
• Delayed capillary
• Delayed capillary
refill time
refill time
• Cool and pale
• Cold
 Management
• Resusciation
• ORS
• IV fluid
• Anti-emetic and anti diarrhea
 Treatment
• Treatment
– Calculate deficits
• Water: % dehydration x weight
• Sodium: water deficit x 80 mEq/L
• Potassium: water deficit x 30 mEq/L
– Treat mild-moderate dehydration with oral
rehydration solutions
– May treat severe dehydration with intravenous
fluids
– Hyponatremic v. isotonic v. hypernatremic
• Replacement of established deficit
– After 48h of moderate diarhea (6-10stools/24h), 1-
2L loss.
– Shall start rapid replacement of 1-1.5L (ORS/NS)
within first 2-4h of presentation
• Replacement of ongoing losses
– One ORS sacher per diarrhoea/vomit
• Replacement of normal daily requirement
– Average daily adult: 1-1.5L
• Anti-diarrhea and anti-vomiting agent usually
not required.