D&V in kids
embeds
November 26, 2019
Paediatric gastroenteritis can be a pain for everyone but as with most of EM – Keep It Simple
- Not dehydrated – make sure they can tolerate fluids, and encourage hydration, think about ORT
- Dehydrated – look for the red flags that indicate they are developing shock. Use ORT unless IV indicated
- Shocked – you will need access and it will probably be difficult (IO on awake children really isn’t that bad)
Severity
Differentials
- Gastroenteritis/Food poisoning
- Systemic Infection [UTI, Pneumonia, Sepsis]
- Surgical [Appendicitis, intussusception, Bowel Obstruction, Mal-rotation]
- Medical [DKA, HUS, Congenital adrenal hyperplasia, raised ICP]
Prevent Dehydration
- Continue breastfeed/milk
- Encourage fluid Intake
- Discourage fruit juice or Soda
- Offer Oral rehydration therapy
Treating dehydration
Use Oral Rehydration Therapy unless IV fluid indicate
- 50ml/kg over 4 hours
- Frequent small volumes
- Consider supplementing
- with usual fluids
- Consider giving via NG (if cant unable to drink)
- Consider admission to Paediatrics
IV Therapy
- Shock or suspected shock
- Red flags/fields
- Not tolerating ORT
Get Senior Support
Shock/Suspected Shock – 20ml/kg, 0.9% NaCl
Rehydration strategies
- 0.9% NaCl +/- 5% glucose
- Shocked (10% dehydrated)
- Add 100ml/kg to maintenance
- Not Shocked (5% dehydrated)
- Add 50ml/kg to maintenance
- Not Shocked [hypernatremia]
- Replace deficit over 48 hours
- Shocked (10% dehydrated)
Maintenance fluid – based on total weight
- 0-12.9kg – 80ml/kg/24hr
- 13-19.9kg – 65ml/kg/24hr
- 20-34.9kg – 55ml/kg/24hr
- 35-59.9kg – 45ml/kg/24hr
- >60kg – 35ml/kg/24hr
PDF:dvp