Gastroenteritis and Dehydration Clinical Pathway — Emergency Department

Emergency Department Clinical Pathway for Healthy Children with Dehydration from Gastroenteritis or Other Acute Illness

Goals and Metrics
Patient Education
Provider Resources
Healthy Child with Dehydration from Gastroenteritis (GE) or Other Acute Illness
  • Consider POC glucose/BOHB if ESI 2/3
    • Glucose < 70 mg/dL, notify Attending
  • Consider ondansetron, ORT for N/V
ED Team Assessment
Minimal/Mild Dehydration
Moderate Dehydration
Severe Dehydration
Consider ondansetron
  • Consider ondansetron
    • Initiate ORT 20 mins after ondansetron
    • ORT Video  
  • Consider POC glucose/BOHB
  • Consider immediate IV rehydration
Discharge
  • Provide oral syringes, medicine cup
  • ORT Video  
Adequate PO
Inadequate PO
IV Rehydration, Consider BMP
Indication Fluid Amount and Type
Hypoglycemia and Ketosis
  • 2 mL/kg D10W
  • Recheck glucose in 30 mins
  • Give 20 mL/kg NS
  • Consider D5NS bolus, Max 500 mL,
    to aid in ketone clearance
Euglycemia
and Ketosis
  • Give 20 ml/kg NS
  • Consider D5NS bolus, Max 500 mL,
    to aid in ketone clearance
Reassess
Vital signs, clinical appearance, ongoing losses
Discharge
  • Provide oral syringes, medicine cup
  • ORT Video  
Admit
EDECU or Inpatient
Gastroenteritis/Dehydration Inpatient Pathway
  • Hypoglycemia
    • Definition: < 70 mg/dL in all ages
    • Give 2 ml/kg of D10W or glucose containing PO fluids
    • Recheck glucose in 30 mins
  • Oral Rehydration Therapy (ORT)
    • Give 1-2 mL/kg; max 30 mL every 5 mins
    • > 1 year old: Gatorade or ½ strength apple juice
    • < 1 year old: Pedialyte
  • Definition of ORT Failure
    • GE: persistent emesis or fluid refusal > 30 mins
      after ondansetron
    • Other illness: fluid refusal after pain management
Weight (kg) PO Single Dose
Ondansetron for GE (mg)
8-15 2
> 15-30 4
> 30 8
Posted: August 2007
Revised: July 2024, Revisions
Editors: Clinical Pathways Team