Makindo Medical Notes

Related Subjects: |Rotavirus |Norovirus |Diarrhoea (Children) |Dehydration (Child) |Viral Gastroenteritis (Adults and Children) |Gastroenteritis in Children |Acute Appendicitis |Acute Appendicitis in Children |Gastro-oesophageal reflux in Children |Intussusception in Children |Gastroenteritis in Children

Introduction:

• Diarrhoea can be an early sign of any septic illness. Faeces may be so liquid that they may be mistaken for urine.
• It is important to note that breastfed babies often have liquid stools, which is a normal variation.
• Gastroenteritis affects children worldwide. Approximately 1.5 million children die annually due to diarrhoeal diseases.

Causes of Gastroenteritis

• Rotavirus is the most common cause of gastroenteritis in infants and children, responsible for around 600,000 childhood deaths annually.
• Other common enteric viruses include: Norovirus (the most common cause in adults), Astrovirus, Adenovirus.

Tests and Diagnosis

• Stool tests should be performed to identify the presence of bacteria, ova, cysts, and parasites.

Complications

• Dehydration: One of the most common complications of gastroenteritis, requiring urgent treatment.
• Malnutrition: Prolonged episodes of gastroenteritis can lead to nutritional deficiencies.
• Temporary sugar intolerance: Following diarrhoea and vomiting (D&V), some children may develop temporary sugar intolerance, presenting with explosive watery, acid stools. This is rare but can be managed with a lactose-free diet for a short period.
• Post-enteritis enteropathy: This condition, characterized by intestinal dysfunction, typically resolves spontaneously after approximately 7 weeks.

Management

• Dehydration: If a child is dehydrated, it is critical to start oral rehydration therapy (ORT) with fluids such as Dioralyte® (50mL/kg over 4 hours, which is approximately 1mL/kg every 5 minutes). This will help to restore hydration.
• If a recent weight is known, it can be used to monitor progress and quantify the degree of dehydration. Continue breastfeeding, even if the child has diarrhoea.
• If the child refuses ORT, offer alternative fluids like water or bottle milk, but avoid fruit juice. If necessary, ORT can be administered via a nasogastric tube.
• IV therapy is only required for children who deteriorate or present in shock.
• Reintroduce milk after 4 hours of rehydration, or sooner if the child recovers and is hungry (starving may harm the child).
• Use of antiemetics (such as ondansetron 0.1–0.15mg/kg) can help decrease vomiting and reduce the need for IV fluids, hospital admission, and overall costs. However, this treatment is not officially recommended in all guidelines.

Prevention

• Good hygiene practices are essential for preventing gastroenteritis. This includes regular handwashing, proper sanitation, and safe food handling.
• Ensuring access to clean water and safe food is crucial for reducing the risk of gastroenteritis.
• Education on proper hygiene and infection control can significantly reduce the incidence of gastroenteritis.
• Fly control is also an important factor in reducing the spread of enteric infections.

Conclusion

• Gastroenteritis is a common and serious condition in children that can lead to dehydration, malnutrition, and other complications if not managed promptly.
• Appropriate treatment with oral rehydration therapy, careful monitoring, and in some cases, the use of antiemetics can significantly improve outcomes.
• Prevention through hygiene, food safety, and vaccination (e.g., rotavirus vaccine) plays a key role in reducing the global burden of gastroenteritis.

References

• Study on the impact of rotavirus: ~600,000 childhood deaths annually due to rotavirus infection.
• WHO guidelines on management of gastroenteritis and dehydration.