Gastroenteritis: An Evidence-Based Approach To Typical Vomiting, Diarrhea, And Dehydration

Hostetler, Mark A MD, MPH, FACEP, FAAP
Nakanishi, Albert K MD, MPH, FAAP
Whiteman, Paula J MD, FACEP

¹Author
²Assistant Professor, Department of Pediatrics, and Chief, Section of Emergency Medicine, University Of Chicago, Pritzker School of Medicine—Chicago, IL.
³Peer Reviewers
⁴Associate Professor of Pediatrics, Saint Louis University School of Medicine, Cardinal Glennon Children's Hospital—Saint Louis, MO.
⁵Medical Director, Pediatric Emergency Medicine, Encino-Tarzana Regional Medical Center; Attending Physician, Cedars-Sinai Medical Center—Los Angeles, CA.

Date of original release: December 31, 2004.

Date of most recent review: December 29, 2004.

See “Physician CME Information” on back page.

Pediatric Emergency Medicine Practice 1(5):p 1-19, December 2004.

Gastroenteritis season is upon us! Your ED and waiting room are overflowing with anxious parents who have brought their children to you with varying degrees of vomiting, diarrhea, and dehydration. The charge nurse is concerned that things are getting backed up. Every parent insists that their child is severely dehydrated and needs intravenous fluids and admission. Many of your strongest nurses, on the other hand, seem to think that almost none of these children needed to be brought to the ED in the first place, and they have started “PO challenges” on just about every child.

As you prepare to evaluate the next patient in the to-be-seen rack, you realize that the ED really is getting terribly backed up. Whereas “putting in an IV and checking some lytes” seemed reasonable when there were just a few children presenting with vomiting and diarrhea, you realize it is time to get very serious about the situation. You need to figure out which children truly need intravenous hydration and laboratories checked, which children are appropriate candidates for oral rehydration, and which parents need some quick reassurance and the discharge papers.

During inevitable winter nights like this, several questions enter your mind. Are any of those published practice guidelines worth the paper on which they're printed? If so, do they apply tomypatients inmyED? What's the deal with oral rehydration? Are there any fluids I am not supposed to be using, and if so, why not? How can I reliably identify the dehydrated kids? Are any labs helpful, and if so, in what circumstances? Did I wash my hands after that last patient?