ED Pathway for Evaluation/Treatment of Children with
Gastroenteritis and Dehydration
ORT

DEFINITION OF ORT FAILURE
  • >1 emesis
  • Refusal to take from syringe/cup for >30 minutes

 

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Weight (kgs)PO Ondansetron Dose (mgs)
8-152
>15-304
>308
Less than 6 months and/or
8 kgs, consult Attending Physician
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Minimal/Mild Dehydration
(1-3% Estimated Deficit)
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  • Consider Ondansetron
  • Teach ORT
  • Give Instruction Sheet to Family
  • Provide oral syringes, medicine cup
  • Discharge
    • Observation of ORT in
      ED as clinically indicated
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Moderate Dehydration
(4-5% Estimated Deficit)
Dehydrated on PE, mild tachycardia, may have small-moderate ketonuria if POC Urine done
Dehydrated on PE, tachycardia, moderate-large ketonuria
Ondansetron/ORT
Reassess 1 hour:

Dehydration Assessment Tool
VS Intake and output

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ORT Success
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Failed ORT
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IV Rehydration
Obtain baseline electrolytes BUN/Creatinine
Bedside glucose as clinically indicated
  1. NS 20 mL/kg IV over 30 min
  2. D5NS 20 mL/kg over 60 min
  3. PO trial
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Tolerates PO Trial
Fails PO Trial
Moderate/Severe Dehydration
(>5% Estimated Deficit)
Posted: August 2007
Revised: August 2011, October 2014, August 2015
Authors: M. Joffe, MD; M. Blackstone, MD; J. Lavelle, MD; T. Crowley, RN; D. Hoser-Glatts, RN