Acute Gastroenteritis Inpatient Pathway



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Acute Gastroenteritis Inpatient Pathway
  • Discontinue IV fluids
  • Increase ORT/Diet
  • 10 mL q5 min if < 10 kg
  • 20 mL q5 min if ≥ 10 kg
  • Reassess q2-4 hours

No improvement after 12-24 hours¥

(Go to Access box)

Are both criteria met?

  • No emesis in past 2 hours
  • No excessive diarrhea

Evaluate for discharge if tolerating ORT OR diet

Oral Rehydration Therapy (ORT) or Regular Diet Challenge

  • ORT: 5 mL q5 min if < 10 kg, 10 mL q5 min if ≥ 10 kg OR resume regular diet
  • Reassess after 1 hour
  • Discontinue NG fluids if patient has NG

  • Admit to Hospital Medicine Service
  • Hand out AGE Admission Kit
  • Order strict I/O’s

Discuss IV vs. NG placement with caregiver*

Continue maintenance IV/NG fluids

MD/RN reassess readiness for oral challenge q2-4 hours

Insert IV or NG

Consider child life

¥ Access: Does the patient have an NGT or IV?

Emesis after ORT?

OR

Refusing PO?

Consider other diagnoses if no improvement after 48 hours

Hold ORT for 1 hour

Consider Zofran

*IV vs. NGT Pros & Cons

IV:

  • Pros: can use immediately
  • Cons: can be difficult to place, infiltrates, phlebitis

NG:

  • Pros: more physiologic, easier to place
  • Cons: patient can pull out, need XR to confirm position

Get Well Network has videos on NGTs

  • Conduct History & Physical
  • Assess hydration status
Inclusion Criteria
  • Patients ≥ 3 months with vomiting and/or diarrhea due to presumed gastroenteritis
Exclusion Criteria
  • Suspected increased ICP
  • Sepsis/Toxic appearance
  • Acute surgical abdomen
  • Diarrhea >7 days
  • Bloody diarrhea
  • Bilious emesis
  • NGT or GT dependent at baseline
  • Medically Complex Children including LINCs patients
  • Renal or cardiac disease
  • Chronic GI disease (e.g. IBD)
  • Antimicrobials and lab testing are not routine recommended
  • Probiotics do not resolve symptoms faster
  • Consider IV NS or NG pedialyte bolus
  • Start IV D5 NS or NG pedialyte at maintenance rate
  • Add K to IVF once patient has voided
  • <10kg: 10mEQ KCL/L
  • ≥10kg: 20 mEQ KCL/L

Discharge Criteria

  • Hydrated on exam
  • Tolerating fluids or regular diet
  • Decreasing frequency/volume of emesis and diarrhea
  • Voiding adequately
  • Adequate family teaching and follow-up established