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

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  
  • 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: June 2024, Revisions
Editors: Clinical Pathways Team