- Related Pathway
- Gastroenteritis/Dehydration, Inpatient
- Related Video
- How to Treat Dehydration from Stomach Bugs in Children
Triage
ED Nursing Pathway Standing Orders: Gastroenteritis/Dehydration
ORT
- Preferred method very successful in treating healthy children with GE/dehydration.
- Children with no/mild dehydration can be discharged home after ORT education.
- Provide 1-2 mL/kg, max 30 mL every
5 minutes. - Differs from PO challenge which is offering ad lib fluids.
- ORT Instructions for the Medical Team
- Instructions for the Family
- ORT Record Sheet
- How to Treat Dehydration from Stomach Bugs in Children
DEFINITION OF ORT FAILURE
- > 1 emesis after Ondansetron
- Refusal to take from syringe/cup for
> 30 minutes
HYPOGLYCEMIA
- Defined as glucose < 70 in all ages
- Give 2mL/kg of D10W
- Start glucose containing maintenance fluids immediately
- Recheck glucose in 30 minutes
8-15 | 2 |
> 15-30 | 4 |
> 30 | 8 |
Consider PO Ondansetron if any emesis within the preceding 4 hours. Children less than 6 months and/or 8 kg, consult Attending Physician Relative Contraindications with Ondansetron |
- Frontline Ordering Clinician (FLOC) Team Rapid Assessment
- Mental status, vital signs
- History & physical exam
- Dehydration Assessment Tools
- Consider POC glucose, BOHB if suspected moderate/severe dehydration
Significant Hypoglycemia
straight to IV Rehydration
Minimal/Mild Dehydration
- Consider Ondansetron
- Nursing discharge teaching
- Give instruction sheet
to family - Provide oral syringes, medicine cup
- ORT video
Moderate Dehydration
Beta-
hydroxybutyrate,
BOHB < 3
Beta-
hydroxybutyrate,
BOHB > 3
- Consider Ondansetron
- RN Plays ORT video
Provides ORT Record Sheet, syringe - Initiate ORT 20 minutes after Ondansetron
- Assess PO intake 1 hour after Ondansetron
ORT Success
ORT Failure
IV Rehydration
- Basic Metabolic Profile
- Treat hypoglycemia with 2 mL/kg of D10W
- Recheck glucose every 30 mins until normal
- NS 20 mL/kg IV
- Consider D5NS 20 mL/kg over 60 min to assist in ketone clearance
- Start glucose containing maintenance fluids if initially hypoglycemic
- ORT vs admission
Reassess
Vital Signs, Clinical Appearance, Ongoing Losses
- Dehydration mild of resolved
- ORT Teaching
- Discharge to continue ORT at home
- Have family review
Oral Rehydration Video
- Considerations for admission:
- ORT failure
- Hypoglycemia and/or significant electrolyte abnormalities
- Continue need for IV Rehydration
- Medical condition requiring inpatient care
Severe Dehydration
Posted: August 2007
Revised:
June 2022
Authors: M. Joffe, MD; M. Blackstone, MD; J. Lavelle, MD; D. Hoser-Glatts, RN
Red Flag Exclusion Criteria
Child at risk of significant harm
Suspected non-accidental injury
Unplanned repeat ED presentation
Child ≤ 2 years
Adult ≥ 65 years
Hydration status in adults assessed as moderate (≥ 5%) or severe (≥ 10%) dehydration
Children assessed as having mild (3%) dehydration who have failed Trial of Oral Fluid
Blood in vomit or stool
Green in vomit
Vomiting without diarrhoea
Abdominal tenderness or distension
Increasing / worsening abdominal pain
Diabetes
Immunocompromised
Altered level of consciousness / agitation
History of workplace injury
Yellow or Red Zones observations or additional criteria outlined in the NSW Health Standard Observations Charts
Additional Observations
Assess hydration status including
Urine output
Mucous membranes
Thirst
Skin turgor
Capillary refill
Blood glucose level
Obtain MSU and complete urinalysis if positive leucocytes or nitrites send for MCS as per local protocols
Consider obtaining a stool sample & send for MCS & OCS as per local protocols
Commence fluid balance chart
Additional History
Social / infectious contacts history
Management Principles
Gastroenteritis clinical practice guidelines (paediatric or adult) should be used in conjunction with this NMG
Commence trial of fluids using a recommended oral rehydration solution (ORS) e.g. Gastrolyte® or Hydralyte™ as per Standing Orders
Consider administration of an antiemetic as per Standing Orders
Ondansetron 4mg tablet / wafer
OR
For adult patients ≥ 20 years only, administer metoclopramide with the following considerations:
Tablet: if patient has not vomited in the past hour and is tolerating small frequent amounts of oral fluid
Parenteral: if patient is currently vomiting and unable to tolerate small amounts of oral fluid
Document assessment findings, interventions, investigations and outcomes
References / Further Resources
Patient Factsheet - Diarrhoea and Vomiting
NSW Health (2014) Infants and children: Management of Acute Gastroenteritis (4th Ed.) NSW Kids and Families, Sydney
NSW Ministry of Health (2012) Gastroenteritis in an institution: Control Guideline for Public Health Units, NSW Ministry of Health, Sydney
Furyk, J.S,. Meek, R.A., Egerton-Warburton D. (2015) Medicines in the treatment of emergency department nausea and vomiting. The Cochrane Collaboration, London.