Table 1 Definitions of clinical diagnosis of acute gastroenteritis, vomiting, and standard protocol of oral rehydration solution administration

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