Gastrointestinal

The most common call you’ll get that is GI related will be either vomiting or diarrhoea, these patients were mostly admitted with a condition that is related to those two symptoms such as acute gastroenteritis: Here is what to do if you encounter any of those symptoms:

1. Initial Assessment

  • Check airway, breathing, circulation (ABC). Stabilize if necessary.

  • Assess hydration: Dry mucosa, sunken eyes, lethargy, reduced urine output.

  • Identify red flags:

    • Bilious or projectile vomiting.

    • Severe dehydration or altered mental state.

    • Bloody stools or signs of obstruction.

2. History

  • Onset: Sudden or gradual?

  • Vomitus: Bilious (obstruction), non-bilious (reflux, gastroenteritis), or bloody.

  • Diarrhea: Frequency, consistency, blood/mucus.

  • Associated symptoms: Fever, abdominal pain, headache, or lethargy.

3. Physical Examination

  • Hydration status: Mild (thirsty), moderate (sunken eyes), or severe (shock).

  • Abdomen: Distension, tenderness, or absent bowel sounds.

  • Neurological signs if raised intracranial pressure is suspected.

4. Investigations (if indicated)

  • Electrolytes: For frequent vomiting or severe dehydration.

  • Abdominal imaging: For obstruction or intussusception.

  • Stool culture: If diarrhea is bloody or infectious cause suspected.

5. Management

  • Rehydration:

    • Oral rehydration solution (ORS) for mild to moderate dehydration.

    • IV fluids (e.g., isotonic saline) for severe dehydration.

  • Vomiting:

    • Stop oral intake temporarily.

    • Ondansetron (0.1–0.15 mg/kg) for persistent vomiting.

  • Diarrhea:

    • Continue feeding, including breastfeeding if applicable.

    • Zinc supplementation: 10 mg (<6 months) or 20 mg (≥6 months) daily for 10–14 days.

    • Avoid sugary drinks that may worsen diarrhea.

  • Specific treatments:

    • Antibiotics only if bacterial infection suspected.

    • Surgical referral for obstruction or other red flags.

6. Monitoring

  • Regularly reassess hydration, vitals, and symptom progression.

  • Resume oral intake gradually as symptoms improve.

This ensures stabilization, rehydration, and timely escalation for underlying causes.

Important classification to know is the degrees of dehydration and how they commonly present:

Look at the others section to know how to calculate IV fluids for children

Dehydration in children is categorized into mild, moderate, and severe based on clinical signs and symptoms. Here's a breakdown:

Degrees of Dehydration

1. Mild Dehydration (3–5% fluid loss)

  • Signs:

    • Thirst.

    • Slightly dry mucous membranes.

    • Normal vital signs and mental status.

    • Normal urine output or slightly decreased.

  • Management:

    • Oral Rehydration Therapy (ORT):

      • Use oral rehydration solution (ORS).

      • Give 50 mL/kg over 4 hours, plus additional for ongoing losses (e.g., 10 mL/kg per stool or vomit).

      • Encourage continued breastfeeding or normal diet.

2. Moderate Dehydration (6–9% fluid loss)

  • Signs:

    • Dry mucous membranes.

    • Sunken eyes and reduced skin turgor.

    • Irritability or fatigue.

    • Increased heart rate and slightly delayed capillary refill (2–3 seconds).

    • Reduced urine output.

  • Management:

    • ORT (if tolerated):

      • Give 100 mL/kg over 4–6 hours, plus ongoing losses.

      • Administer ORS in small, frequent sips or via a syringe/spoon.

    • IV Fluids (if ORT not tolerated):

      • Start with 0.9% saline or Ringer's lactate at 20 mL/kg over 1 hour, reassess, and switch to maintenance fluids once stabilized.

3. Severe Dehydration (≥10% fluid loss)

  • Signs:

    • Lethargy or altered mental state.

    • Very dry mucous membranes.

    • Sunken eyes and fontanelle.

    • Rapid, weak pulse or hypotension.

    • Delayed capillary refill (>3 seconds).

    • No urine output or very dark urine.

  • Management:

    • Immediate IV Fluid Resuscitation:

      • Bolus: 20 mL/kg isotonic saline or Ringer's lactate as quickly as possible.

      • Repeat boluses until signs of shock resolve (up to 3 boluses, then escalate care).

    • Correct ongoing dehydration:

      • Replace the remaining deficit with 0.9% saline or Ringer's lactate over 24–48 hours.

    • Monitor electrolytes, urine output, and vitals closely.

    • Switch to ORT as the child stabilizes and tolerates oral intake.

Key Points in Management

  1. Ongoing Losses: Always account for ongoing stool or vomit losses with additional ORS or fluids.

  2. Reassess Frequently: Monitor hydration status, mental state, heart rate, urine output, and weight regularly.

  3. Gradual Return to Normal Diet: Resume regular feeding, including breastfeeding, as soon as possible.