Emergency Department Clinical Pathway for Healthy Children
with Gastroenteritis/ Dehydration
- Related Pathway
- Gastroenteritis/Dehydration, Inpatient
Triage
ED Nursing Pathway Standing Orders: Gastroenteritis/Dehydration
ED Nursing Pathway Standing Orders: Gastroenteritis/Dehydration
Oral Rehydration Therapy (ORT)
- Preferred method very successful in treating healthy children with GE/dehydration
- Children with no/mild dehydration can be discharged home after ORT education
- Provide 1-2 mL/kg, max 30 mL every
5 mins - Differs from PO challenge which is offering ad lib fluids
- ORT Instructions for the Medical Team
- Instructions for the Family
- ORT Record Sheet
- How to Treat Dehydration from Stomach Bugs in Children
- > 1 emesis after ondansetron
- Refusal to take from syringe/cup for
> 30 mins
- Defined as glucose < 70 in all ages
- Give 2mL/kg of D10W
- Start glucose containing maintenance fluids immediately
- Recheck glucose in 30 mins
Weight (kg) | PO ondansetron Dose (mg) |
---|---|
8-15 | 2 |
> 15-30 | 4 |
> 30 | 8 |
|
- FLOC/RN Team Assessment
- Mental status, VS
- History and physical exam
- Dehydration Assessment Tools
- Consider POC glucose, BOHB if suspected moderate/severe dehydration
Significant hypoglycemia,
straight to IV rehydration
straight to IV rehydration
Minimal/Mild Dehydration
- Consider ondansetron
- RN discharge teaching, give instruction sheet to family
- Provide oral syringes, medicine cup
- ORT video
Moderate Dehydration
Beta-
hydroxybutyrate,
BOHB < 3
hydroxybutyrate,
BOHB < 3
Beta-
hydroxybutyrate,
BOHB > 3
hydroxybutyrate,
BOHB > 3
- Consider ondansetron
- RN plays ORT video
Provides ORT record sheet, syringe - Initiate ORT 20 mins after ondansetron
- Assess PO intake 1 hr after ondansetron
ORT Success
ORT Failure
IV Rehydration
- Basic metabolic profile
- Treat hypoglycemia with 2 mL/kg of D10W
- Recheck glucose every 30 mins until normal
- NS 20 mL/kg IV
- Consider D5NS 20 mL/kg (max 500 mL) over 60 mins to assist in ketone clearance
- Start glucose containing maintenance fluids if initially hypoglycemic
- ORT vs. admission
Reassess
Vital signs, clinical appearance, ongoing losses
Vital signs, clinical appearance, ongoing losses
- Dehydration mild or resolved
- ORT teaching to continue
at home - Family reviews
Oral Rehydration Video
Admit EDECU or Inpatient
EDECU Rehydration Recommendations
EDECU Rehydration Recommendations
- Considerations for admission:
- Significant ongoing losses
- Unable to tolerate PO fluids, ORT failure
- Continued need for IV rehydration
- Hypoglycemia or significant electrolyte abnormalities
- Medical condition requiring inpatient care
Severe Dehydration
Evidence
- Value of Point-of-care Ketones in Assessing Dehydration and Acidosis in Children with Gastroenteritis.
- The Use of a Triage-Based Protocol for Oral Rehydration in a Pediatric Emergency Department
Related Links
- CDC - Managing Acute Gastroenteritis Among Children
- CDC - Norovirus
- Diarrhea and Dehydration, Module 6 of the Pediatric Education in Disasters Manual
Educational Media