Flashcards in 3 - Paeds - Gastro - Gastroenteritis Deck (14):
commonest cause? what suggests bacterial cause? commonest bacterial cause? gives what symptom?
blood in stools
campylobacter jejuni - (bact less common) -ass w severe abdo pain
what happens? suggestive Hx points? what is most serious complication?
sudden change to water stools and vomiting
ate from a dodgy place/travel abroad
dehydration > shock - prevention/correction of this is main therapeutic goal
why are infants at higher risk of shock from dehydration
greater SA:W ratio so more insensible water losses, higher basal fluid req, immature renal tubular reabsorption and can't obtain fluids when wanted
5 RF's for worse disease course?
infants <6m/low birth wt
>6 diarrhoeal stools in last 24 h
>3 vomits in last 24 h
unable to tolerate extra fluids
how to assess hydration? 3 different bandings?
degree of wt loss during diarrhoeal illness
-no clinically detectable dehydration (<5% loss)
-clinical dehydration (5-10% loss)
-shock (>10% loss)
inc intracellular vol > inc brain vol > convulsions
depleted EC vol > greater degree of shock per unit of water loss
hypernatraemic dehydration - Sx
jittery movement, inc muscle tone, hyperreflexia, convulsions, drowsiness, coma
What red flags signs help to identify children at risk of progression to shock..??
reduced skin turgor
stool culture if septic,or blood/mucus in stool or immunocompromised or if ABx given
MGMT - no clinical dehydration?
- continue BF +/or formula
- encourage fluids
- Oral rehydration solution (ORS) if at risk of further dehydration
MGMT - clinical dehydration
ORS - often and small amounts
fluid deficit replacement fluids -> 50ml/kg over 4h as well as maintenance fluid
inadequate intake/vomits persistently -> ORS via NG tube
MGMT - shock?
IV therapy - rapid infusion of 0.9% NaCl solution - repeat if needed
if remains shocked - consider PICU help
MGMT - clinical dehydration > deterioration/vomiting) OR if shock Sx/signs improve....do what?
IV therapy for rehydration
-replace deficit + maintenance fluids
-deficit = 10% of weight if shocked 5% if not shocked
-monitor plasma electrolytes, urea, creatinine, glucose
-consider IV K+ supplement
-continue BF if possible