Hydration Guidelines for Pediatric Patients with Vomiting and/or Diarrhea
PURPOSE:
To assess and address dehydration and initiate treatment to prevent further clinical decline in children >6m with vomiting +/- diarrhea triaged CTAS 3,4,5
The hydration guidelines will be implemented in Triage level 3, 4 and 5 children who are greater than 6 months old presenting with a history of vomiting and/ or diarrhea with no abdominal pain other than expected cramping.
Inclusion:
- >6m-10y
- children with nausea
- vomiting or diarrhea
- mild dehydration
- CTAS 3,4,5.
Exclusion:
- <6m, >10y
- severe dehydration
- CTAS 1,2
- symptoms >7 days
- focal abdominal pain
- PMHx
- inborn errors of metabolism
- diabetes
- immuno deficiency
- major organ system disorder
- signs of symptoms of bowel obstruction
- distention
- bilious emesis
- absent bowel sound
Process:
Children presenting with moderate or severe dehydration must be triaged at Level 1 or 2 and seen by a physician prior to initiating treatment.
Equipment:
- Medicine cup or oral syringe
- Oral rehydration solution (ORS) ie: Pedialyte
Procedure:
- Instruct and encourage parents/caregivers to administer hydration therapy with ORS using the medicine cup or oral syringe and record intake/output
- Oral hydration should begin in the waiting room before the child’s condition deteriorates and further GI losses occur. Juice may be substituted for ORS, mix 1/3 juice with 2/3 water.
Re-Assessment:
Re-Assessment and monitoring of child’s compliance, improvement or deterioration, according to the following:
- Triage level 3 = q 30 minutes
- Triage level 4 = q 1 hour
- Triage level 5 = q 2 hour
Documentation
- Vital signs
- Intake output
- Solution type taken
- Response to therapy
- Ongoing losses
Ondansetron
Ondansetron is the antiemetic of choice in the treatment of dehydration associated with pediatric gastroenteritis. There is no role for multiple doses, or the alternative use of dimenhydrinate.
References:
- Armon,K.,T.,MacFaul,R.,Eccleston,P.,&Wemcke,U.(2001). March An Evidence and Consensus Based Guideline For Acute Diarrhea Management.
- Burkhart,D.(1999)December .Management of Acute Gastroenteritis in Children. American Family Physician. Vol.60(9) .
- CAEP, COT retrieved Dec 2009-12-14.
- Hugger,J.,Gene,H.,&Rentschler,D.(1998). December. Oral Rehydration Therapy for children with Acute Diarrhea. Vol.23(12) .
- Jarvis,C.(1996). Physical Examination and Health Assessment. 2nd edition.
- Trekk, Friedman S, & Trekk Network. Bottom Line: Gastroenteritis (2016)
- Watt,J.,(1999). April. Acute Gastroenteritis in children. Australian Family Physician. Vol.28(4)
