3 - Paeds - Gastro - Gastroenteritis Flashcards
commonest cause? what suggests bacterial cause? commonest bacterial cause? gives what symptom?
rotavirus
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 malnutrition
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)
Iso/hyponatraemic dehydration…
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..??
appears unwell/deteriorating altered responsiveness sunken eyes tachycardia tachypnoea reduced skin turgor
Ix????
usually none
stool culture if septic,or blood/mucus in stool or immunocompromised or if ABx given
MGMT - no clinical dehydration?
prevention!
- 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
MGMT - after rehydration therapy?
full strength milk + reintroduce usual solid food
avoid fruit juice + sodas
do not go back to child care/school for 48h after last episode
