Emergency Department Clinical Pathway for Healthy Children with Gastroenteritis/ Dehydration
- Related Pathway
- Gastroenteritis/Dehydration, Inpatient
- Related Video
- How to Treat Dehydration from Stomach Bugs in Children
Triage
ED Nursing Pathway Standing Orders: Gastroenteritis/Dehydration
ED Nursing Pathway Standing Orders: Gastroenteritis/Dehydration
ORT
DEFINITION OF ORT FAILURE
HYPOGLYCEMIA
- 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 minutes. - 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 minutes
- Defined as glucose < 70 in all ages
- Give 2mL/kg of D10W
- Start glucose containing maintenance fluids immediately
- Recheck glucose in 30 minutes
Weight (kgs) | PO Ondansetron Dose (mgs) |
---|---|
8-15 | 2 |
> 15-30 | 4 |
> 30 | 8 |
Consider PO Ondansetron if any emesis within the preceding 4 hours. Children less than 6 months and/or 8 kg, consult Attending Physician |
- Frontline Ordering Clinician (FLOC) Team Rapid Assessment
- Mental status, vital signs
- History & 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
- Nursing 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 minutes after Ondansetron
- Assess PO intake 1 hour 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 over 60 min 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 of resolved
- ORT Teaching
- Discharge to continue ORT at home
- Have family review
Oral Rehydration Video
- Considerations for admission:
- ORT failure
- Hypoglycemia and/or significant electrolyte abnormalities
- Continue need for IV Rehydration
- Medical condition requiring inpatient care
Severe Dehydration
Posted: August 2007
Revised: June 2022
Authors: M. Joffe, MD; M. Blackstone, MD; J. Lavelle, MD; D. Hoser-Glatts, RN
Revised: June 2022
Authors: M. Joffe, MD; M. Blackstone, MD; J. Lavelle, MD; D. Hoser-Glatts, RN