Acute gastroenteritis

Background

• Blood diarrhea suggests bacterial etiology
• Viral AGE usually lasts <7d
• Do not dx isolated vomiting as AGE

Diagnosis

• Vomiting/diarrhea
• Crampy/diffuse abdominal pain

Work-Up

• Assess hydration status
  • Cap refill, skin turgor, resp rate
• Consider stool labs if:
  • >10 stools in previous 24hr
  • Travel to high-risk country
  • Fever
  • Bloody stool
  • Persistent diarrhea

DDx

• Viral
• Non-Invasive
• Invasive

Invasive AGE

Species	Onset	Symptoms	Transmission
Salmonella	6-72 hours	Fever Abd pain Headache	Eggs Poultry Water Reptiles
Shigella	1-3 days	Fever abd pain headache 1-5 years old	Food Fecal-Oral
Yersinia	1-5 days	Appy Mimic, RLQ Pain Fever Vomiting Kids and Young Adults	Water Milk Pork Wild Animals Fecal-Oral
Campylobacter	1-7 days	Low grade fever Abd pain Kids and Young Adults	Water Poultry Pets/Animals
C. Dif	1-11 Weeks	Copious FOUL diarrhea	ABX use: PCN, Clinda, Cephalos
Entamoeba	1-11 weeks	Appy Mimic Abd, n/v/d	Water Sanitation Travel

Treatment

1. Oral rehydration therapy
   1. 30mL(1oz)/kg/hr
2. Antiemetic
   1. Ondansetron 0.15mg/kg/dose IV/PO
3. Antibiotics
   1. Only consider in pts w/ invasive infection
      1. Shigella, campylobacter, E. coli, yersinia, vibrio
      2. Bloody stool w/ mucus and fever
   2. NOT indicated for E. coli O157:H7
   3. NOT routinely indicated for salmonella
      1. Exceptions: SCD, IBD, <3mo
   4. Azithromycin (able to tolerate PO)
   5. Ceftriaxone (parenteral)

See Also

Nausea and Vomiting

Diarrhea (Peds)

Dehydration

Source

Tintinalli