Inpatient Clinical Pathway for Healthy Child with Gastroenteritis/Dehydration
- Related Pathways
- Continuous Administration of IV Fluids, Inpatient
- Dehydration, ED
- History and Physical
- Assess
- Risk for Underlying Disease
- Consider Differential Diagnosis
- Level of Dehydration Using Dehydration Assessment Tool
Mild Dehydration
RN notifies FLOC
FLOC confirms ORT readiness
FLOC confirms ORT readiness
- Discontinue IV hydration
- Initiate ORT
- ORT Instructions Medical Team
Tolerates ORT
- Advance to regular diet as tolerated
- Breast milk, formula, solids
Discharge Criteria
- Vital signs within normal limits for age
- PO intake > losses
- Urine output > 1 ml/kg/hr
- Improving frequency of emesis
Fails ORT
- Emesis and/or
- PO refusal
Moderate/Severe Dehydration
- Restore Euvolemia
- Give additional normal saline bolus
- Address Electrolyte Abnormalities
RN Assessment for ORT Readiness, Complete Q4H
- RN notifies FLOC
- FLOC confirms ORT readiness
Ready for ORT
- Discontinue IV fluids
- Initiate ORT or NG
- ORT Instructions for Medical Team
- Advance to regular diet as tolerated
Not Ready for ORT
- Initiate IV hydration
- Replace GI losses
- 1:1 with normal saline Q4H
- Consider additional Zofran®
- Continue Q4 nursing assessments
- Continue IV hydration
- If no improvement in 48 hours
- Consider
- Alternate diagnosis
- Repeat electrolytes
- Oral Rehydration Therapy (ORT)
- Preferred method, successful in treating healthy children with GE/dehydration.
- Give 1-2 mL/kg, max 30 mL every 5 minutes
- Differs from PO challenge which is offering ad
lib fluids - Instructions for the Medical Team
- ORT Record Sheet
- NG Hydration/Feeds
- Consider in patients with persistent GI losses from ongoing diarrhea.
- Discuss with family
- Review
- NG vs. IVF PFE
- Give Pedialyte® at maintenance rate + replacement of fluid losses
- Advance to enteral formula as tolerated
Posted: June 2019
Revised: June 2021
Authors: A. Van Pelt, MD; K. Dellabadia MD; M. Greenfield, MD; J. Hart, MD; K. Granahan, BSN; B. Gallagher, BSN
Revised: June 2021
Authors: A. Van Pelt, MD; K. Dellabadia MD; M. Greenfield, MD; J. Hart, MD; K. Granahan, BSN; B. Gallagher, BSN
Evidence
- European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases Evidence-Based Guidelines for the Management of Acute Gastroenteritis in Children in Europe: Update 2014
- Hospital Management of Children with Acute Gastroenteritis
- Gastroenteritis Therapies in Developed Countries: Systematic Review and Meta-Analysis