Gastroenteritis and dehydration
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Case 1: 11 months old boy
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2 day history of vomiting and diarrhea
Older brother in daycare same symptoms last week
last urine output this morning (now: 4pm)
4 diarrheas today, vomited 2 times
parents can’t get her to drink. The two times she
accepted fluid, she threw up
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Examination
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Uncomfortable, gives contact, no smile
T 38,4
HR 135
skin turgor slightly reduced
capillary refill time 2sec
mucus membranes wet
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Lab
• CRP 8
• Diagnosis?
• Admit to hospital?
• Other solutions?
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Viral gastroenteritis
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
History
• Ensure correct diagnosis! (fever, gastroenteritis in
the family/community, both vomiting and diarrea?)
• Duration
• Amount of ongoing losses
• Ability to maintain an adequate intake
• Urine output
• Weight loss
– <5% mild
– 5-10% moderate
– >10% severe
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Clinical examination
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Capillary refill time
Skin turgor
Respiratory rate
Pulse
Sunken fontanel
Dry mucus membrane
(blood pressure)
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Laboratory investigations
• bicarbonate level (<15-17)
– OBS: profuse vomiting leads to metabolic alkalosis
• urea
• (Na, K, pH, Base Excess, kreatinin, Hb, WBC)
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Treatment
• Oral rehydration
– Commercial solutions
– Small amounts often with teaspoon/syringe
• Nasogastric tube
– Continous supplement
• Intravenous
– NaCl 20ml/kg
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Case 2: 3 months old girl
• 1 day history of vomiting (x1) and diarrhoea
• 3 stools/hour for the last 3 hours. Two large watery
diarrhoeas while in your office
• Accepts some fluid without throwing up, but much
less intake than usually
• Urine output unknown, all dipers are wet of
diarrhoea.
• Slept much more than usual
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Examination
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Smiles, excellent contact. Acitvity looks fine
HR 145, RF 50
Capillary refill time 2 sec
Mucus membranes wet
Turgor OK
• Admit to hospital?
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Case 3: 1,5 years old
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Smiles, excellent contact. Acitvity looks fine
HR 145, RF 50
Capillary refill time 2 sec
Mucus membranes wet
Turgor OK
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat
Examination
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Uncomfortable, difficult to calm, keep crying
T 40
HR 150
Skin turgor ok.
Capillary refill time 3 sec.
Distended abdomen, painful. Some bowel sounds
presents
• Admit to hospital?
Medisinsk Fakultet, Institutt for Klinisk Medisin, Oslo Universitetssykehus, Barneklinikken, Håvard Ove Skjerven, Klinisk Stipendiat