Clinical diagnosis of acute gastroenteritis |
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We refer to the NICE guideline (http://www.nice.org.uk/guidance/index.jsp?action=download&o=42316) that recommends: |
When considering a diagnosis of gastroenteritis, look for the following key characteristics: |
A recent change in stool consistency to loose or watery stools; recent onset of vomiting; recent contact with an individual with acute diarrhoea; exposure to known source of enteric infection (water or food borne); recent foreign travel. |
Consider the following symptoms and signs as possible indicators of diagnoses other than gastroenteritis: |
High fever (age less than 3 months: >38°C; age more than 3 months: >39°C); rapid breathing or labored respirations; altered conscious level (irritability, drowsiness); photophobia, neck stiffness and/or bulging fontanelle (in infants); non-blanching (haemorrhagic) rash; blood and/or mucous in stool; bilious vomiting (green); severe or localized abdominal pain; abdominal distension or rebound tenderness." |
Definition of Vomiting |
According to NICE, we define vomiting as the forceful ejection of the stomach contents up to and out of the mouth (http://www.nice.org.uk/guidance/index.jsp?action=download&o=42316). |
Episodes separated by no more than two minutes are counted as a single episode. Non-productive retching, spilling of oral contents, and drooling were not considered vomiting. |
Standard protocol of oral rehydration solution (ORS) administration |
The following standard protocol is the result of the combination of international guidelines recommendations and study committee consensus derived from ED clinical practice: |
1st hour: |
   -age 1 to 2 years: 50 cc of low osmolarity ORS (sodium 60 mmol/L) administered cold and in small, frequent volumes (small sips, time divided); this amount correspond to 1/2 coffee spoon (equivalent to 1,5 cc) every 2 minutes; |
   -age 3 to 6 years: 100 cc of low osmolarity ORS (sodium 60 mmol/L) administered cold and in small, frequent volumes (small sips, time divided); this amount correspond to 1 coffee spoon (equivalent to 3-3,5 cc) every 2 minutes. |
From 2nd to 6th hour: |
Cold ORS administered at sips following the plan: |
   - Mild dehydration: 30-60 ml/Kg body weight over 4-6 hours |
   - Moderate dehydration: 60-90 ml/Kg body weight over 4-6 hours |