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The management of children with gastroenteritis and dehydration in the emergency department.
J Emerg Med. 2010 Jun; 38(5):686-98.JE

Abstract

BACKGROUND

Acute gastroenteritis is characterized by diarrhea, which may be accompanied by nausea, vomiting, fever, and abdominal pain.

OBJECTIVE

To review the evidence on the assessment of dehydration, methods of rehydration, and the utility of antiemetics in the child presenting with acute gastroenteritis.

DISCUSSION

The evidence suggests that the three most useful predictors of 5% or more dehydration are abnormal capillary refill, abnormal skin turgor, and abnormal respiratory pattern. Studies are conflicting on whether blood urea nitrogen (BUN) or BUN/creatinine ratio correlates with dehydration, but several studies found that low serum bicarbonate combined with certain clinical parameters predicts dehydration. In most studies, oral or nasogastric rehydration with an oral rehydration solution was equally efficacious as intravenous (i.v.) rehydration. Many experts discourage the routine use of antiemetics in young children. However, children receiving ondensetron are less likely to vomit, have greater oral intake, and are less likely to be treated by intravenous rehydration. Mean length of Emergency Department (ED) stay is also less, and very few serious side effects have been reported.

CONCLUSIONS

In the ED, dehydration is evaluated by synthesizing the historical and physical examination, and obtaining laboratory data points in select patients. No single laboratory value has been found to be accurate in predicting the degree of dehydration and this is not routinely recommended. The evidence suggests that the majority of children with mild to moderate dehydration can be treated successfully with oral rehydration therapy. Ondansetron (orally or intravenously) may be effective in decreasing the rate of vomiting, improving the success rate of oral hydration, preventing the need for i.v. hydration, and preventing the need for hospital admission in those receiving i.v. hydration.

Authors+Show Affiliations

Department of Emergency Medicine, Mayo Clinic College of Medicine, Rochester, Minnesota 55905, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

19345549

Citation

Colletti, James E., et al. "The Management of Children With Gastroenteritis and Dehydration in the Emergency Department." The Journal of Emergency Medicine, vol. 38, no. 5, 2010, pp. 686-98.
Colletti JE, Brown KM, Sharieff GQ, et al. The management of children with gastroenteritis and dehydration in the emergency department. J Emerg Med. 2010;38(5):686-98.
Colletti, J. E., Brown, K. M., Sharieff, G. Q., Barata, I. A., & Ishimine, P. (2010). The management of children with gastroenteritis and dehydration in the emergency department. The Journal of Emergency Medicine, 38(5), 686-98. https://doi.org/10.1016/j.jemermed.2008.06.015
Colletti JE, et al. The Management of Children With Gastroenteritis and Dehydration in the Emergency Department. J Emerg Med. 2010;38(5):686-98. PubMed PMID: 19345549.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The management of children with gastroenteritis and dehydration in the emergency department. AU - Colletti,James E, AU - Brown,Kathleen M, AU - Sharieff,Ghazala Q, AU - Barata,Isabel A, AU - Ishimine,Paul, AU - ,, Y1 - 2009/04/05/ PY - 2008/01/13/received PY - 2008/05/12/revised PY - 2008/06/04/accepted PY - 2009/4/7/entrez PY - 2009/4/7/pubmed PY - 2010/9/18/medline SP - 686 EP - 98 JF - The Journal of emergency medicine JO - J Emerg Med VL - 38 IS - 5 N2 - BACKGROUND: Acute gastroenteritis is characterized by diarrhea, which may be accompanied by nausea, vomiting, fever, and abdominal pain. OBJECTIVE: To review the evidence on the assessment of dehydration, methods of rehydration, and the utility of antiemetics in the child presenting with acute gastroenteritis. DISCUSSION: The evidence suggests that the three most useful predictors of 5% or more dehydration are abnormal capillary refill, abnormal skin turgor, and abnormal respiratory pattern. Studies are conflicting on whether blood urea nitrogen (BUN) or BUN/creatinine ratio correlates with dehydration, but several studies found that low serum bicarbonate combined with certain clinical parameters predicts dehydration. In most studies, oral or nasogastric rehydration with an oral rehydration solution was equally efficacious as intravenous (i.v.) rehydration. Many experts discourage the routine use of antiemetics in young children. However, children receiving ondensetron are less likely to vomit, have greater oral intake, and are less likely to be treated by intravenous rehydration. Mean length of Emergency Department (ED) stay is also less, and very few serious side effects have been reported. CONCLUSIONS: In the ED, dehydration is evaluated by synthesizing the historical and physical examination, and obtaining laboratory data points in select patients. No single laboratory value has been found to be accurate in predicting the degree of dehydration and this is not routinely recommended. The evidence suggests that the majority of children with mild to moderate dehydration can be treated successfully with oral rehydration therapy. Ondansetron (orally or intravenously) may be effective in decreasing the rate of vomiting, improving the success rate of oral hydration, preventing the need for i.v. hydration, and preventing the need for hospital admission in those receiving i.v. hydration. SN - 0736-4679 UR - https://www.unboundmedicine.com/medline/citation/19345549/The_management_of_children_with_gastroenteritis_and_dehydration_in_the_emergency_department_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0736-4679(08)00596-9 DB - PRIME DP - Unbound Medicine ER -