Danger signs of acute gastro

by Richard Haber, MD
 
Mrs. Pontifex has a 14-month-old daughter in daycare. This morning, the toddler was vomiting and had a slight fever and now she’s having frequent watery stools. What telephone advice should you give? What are the danger signs that mandate a visit to the office or the emergency room (ED)?
Diagnostic clues and tips

Diagnostic clues and tips

Most cases of diarrhea and vomiting are relatively benign and self-limiting. The major threat is fluid loss, resulting in dehydration and electrolyte imbalance. Though this can generally be prevented with appropriate fluid management at home, babies younger than 2 years are at greatest risk for these complications. Over the telephone, try to ferret out the state of the child’s hydration. Urine output remains a cardinal sign — are there less than 4 wet diapers in 24 hours? Is the baby’s fontanel sunken? Is there increased thirst? Are there tears? Is the heart rate faster than normal? Any of these signs mandate evaluation in your office. Blood in the stool also indicates more than a simple virus.
 
Tip — be cautious with the infant who has persistent high fever and vomiting, with no diarrhea: these signs could indicate sepsis or meningitis. Second tip — has there been any foreign travel? This may point in the direction of an unusual pathogen. In general, there are no parasites in Canada causing acute gastroenteritis. Giardia lamblia may be implicated in chronic, watery stools but isn’t usually a cause of acute illness.
Guidelines for treatment

Guidelines for treatment

Of all the agents producing diarrhea and vomiting, rotavirus is one of the most common — it causes epidemics and is highly contagious. Rotateq is a new vaccine to prevent rotavirus infection especially for children in daycare. The increased incidence of intussusception associated with an earlier vaccine doesn’t appear to be a problem, although surveillance is ongoing.
 
Most infants with diarrhea can be successfully treated with oral rehydration fluids (ORS). There are several commercially available solutions, and these are much better than the homemade ones. Breastfeeding if normally given should continue with additional ORS if necessary. In the first 4-6 hours, for a baby 6 months or younger, 30-90 mL of ORS should be given every hour; for ages 6-24 months, 90-125 mL/hr; over 2 years, 125-250 mL/hr. Continue the ORS over 6-24 hours until vomiting ceases.
 
If a little one refuses rehydration by bottle, it can be offered by spoon, syringe or even special popsicles. Antidiarrheal agents are not recommended in young children. Once vomiting has diminished, even in the presence of continuing diarrhea, it’s allowable for the child to drink formula or whole milk and eat regular food, albeit in small, more frequent servings. Remember that diarrhea may continue for 7-10 days. Sweetened drinks, soda pop and juice should not be given as they may cause exacerbation due to their osmotic properties. If the child shows signs of dehydration despite treatment, a visit to the ED will be necessary for intravenous rehydration.
 
Parents can go to the Canadian Paediatric Society’s online guide on a variety of subjects (www.caringforkids.cps.ca/index.htm).

Richard Haber, MD, FAAP, FRCPC is an associate professor of pediatrics at McGill University and the Director of the Pediatric Consultation Centre at The Montreal Children’s Hospital.
 
Related articles:

Related articles:

Rotavirus Infection in Children
Gastroenteritis in children