ED Clinical Pathway for Healthy Child with Gastroenteritis/Dehydration
ORT
DEFINITION OF ORT FAILURE
  • > 1 emesis after Ondansetron
  • Refusal to take from syringe/cup for
    > 30 minutes
HYPOGLYCEMIA
  • 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

Relative Contraindications with Ondansetron

Significant Hypoglycemia
straight to IV Rehydration
Minimal/Mild Dehydration
  • Consider Ondansetron
  • Nursing discharge teaching
  • Give instruction sheet
    to family
  • Provide oral syringes, medicine cup
Moderate Dehydration
Beta-
hydroxybutyrate,
BOHB < 3
Beta-
hydroxybutyrate,
BOHB > 3
  • Consider Ondansetron
  • Initiate ORT 20 minutes after Ondansetron
  • Assess PO intake 1 hour after Ondansetron
ORT Success
ORT Failure
IV Rehydration
  • Basic Metabolic Profile
  • NS 20mL/kg IV over 30 min
  • Consider second bolus with D5NS 20 mL/kg over 60 min
  • ORT Trial - ORT is clinically indicated in young kids
  • Discharge for older kids
IV Rehydration
  • Basic Metabolic Profile
  • Treat hypoglycemia as needed
  • NS 20 mL/kg IV over 30 min
  • D5NS 20 mL/kg over 60 min
  • ORT vs admission
Reassess
Vital Signs, Clinical Appearance, Ongoing Losses
  • Dehydration mild of resolved
  • ORT Teaching
  • Discharge to continue ORT at home
  • Considerations for admission:
  • ORT failure
  • Hypoglycemia and/or significant electrolyte abnormalities
  • Continue need for IV Rehydration
  • Medical condition requiring inpatient care
  • For Recent T&A patients with dehydration
    requiring IVF:
    • Discontinue Study Drug
    •  
    •  
    •  
    • Review BMP results, determine need for follow-up
Severe Dehydration
Posted: August 2007
Revised: August 2011, October 2014, August 2015, March 2018
Authors: M. Joffe, MD; M. Blackstone, MD; J. Lavelle, MD; T. Crowley, RN; D. Hoser-Glatts, RN