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Gastroenteritis and Dehydration

Pathway Background and Objectives

Acute gastroenteritis in children is most commonly caused by viral pathogens, accounting for 1.7 million Emergency Department visits and 200,000 hospitalizations annually. Complications of gastroenteritis, include dehydration and/or electrolyte abnormalities and acid base disturbance. Often, oral rehydration therapy (ORT) is an effective treatment, and it is a less invasive alternative to intravenous rehydration.

Additionally, caregivers can be educated on its use at home for ongoing rehydration. Ondansetron, when indicated as an anti-emetic, can help a child to avoid admission if administered promptly. There are many interventions that should not be routine when caring for a child with gastroenteritis. These include laboratory studies such as serum electrolytes and stool studies, and treatments such as restrictive diets and antidiarrheal medications.

The specific objectives of this pathway are to:

  • Standardize care of patients who present with gastroenteritis and dehydration
  • Improve the classification of dehydration as mild, moderate, or severe
  • Standardize use of ondansetron in appropriate patients
  • Increase the use of ORT when appropriate, and improve caregiver education on ORT administration
  • Decrease time to regular diet
  • Decrease unnecessary treatments and laboratory studies (e.g. electrolytes, stool studies, antidiarrheal medications, antibiotics)

Algorithm

Download Gastroenteritis and Dehydration Pathway Algorithm 

Quality Metrics 

  • Percentage of eligible patients with pathway order set utilization
  • Percentage of patients discharged home from the ED (treated and released)
  • Percentage of patients receiving ondansetron (Zofran)
  • Average time from ED arrival to initial Zofran administration (minutes)
  • Percentage of patients receiving IV fluid rehydration
  • Percentage of patients receiving IV rehydration with documented dehydration classification: mild/mod/severe (using Dehydration Assessment tool)
  • Length of Stay in ED (hours) and inpatient/observation (days)
  • Percentage of patients with repeat electrolyte testing
  • Returns to ED within 48 hours
  • Percentage of admitted patients who get chem 7 or chem 10 on floors (not ED)
  • Percentage of admitted patients who have hypernatremia (Na > 145)
  • Percentage of readmission within 48 hours (admitted patients)

Educational Module 

Download Gastroenteritis and Dehydration Educational Module 

Key References

  1. Freedman SB, Samina A, Oleszczuk M, Gouin S, Hartling L. Treatment of Acute Gastroenteritis in Children: An Overview of Systematic Reviews of Interventions Commonly Used in Developed Countries. Evid Based Child Health: A Cochrane Review Journal. 2013 Jul;8(4):1123-37. 
  2. King CK, Glass R, Bresee JS, Duggan C; Centers for Disease Control and Prevention. Managing acute gastroenteritis among children: oral rehydration, maintenance, and nutritional therapy. MMWR Recomm Rep. 2003;52(RR-16):1–16.
  3. Tomasik E, Ziółkowska E, Kołodziej M, Szajewska H. Systematic review with meta-analysis: Ondansetron for vomiting in children with acute gastroenteritis. Aliment Pharmacol Ther. 2016;44(5):438–446.
  4. Nabower AM, Hall M, Burrows J, et al. Trends and Variation in Care and Outcomes for Children Hospitalized with Acute Gastroenteritis. Hosp Pediatr. 2020 Jul;10(7):547-554. doi: 10.1542/hpeds.2019-0310. Epub 2020 Jun 3.

Pathway Contacts

  • Eric Hoppa, MD
  • Ilana Waynik, MD

Disclaimer

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.

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