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click here for freelancing tutoring sitesACUTE GASTRO ENTERITIS WITH MILD DEHYDRATION AND SLIGHT FEVER

Infection occurs via the faecal-oral route. Viral gastro-enteritis has a short incubation period (about 24 hours). It presents with a sudden onset of vomiting and profuse watery (secretory) diarrhea. The condition is self limiting and lasts for 2-3 days. Morbidity and mortality is due to dehydration and young infants are at greatest risk.

Sign and symptoms

According to CDC

Gastroenteritis means inflammation of the stomach and small and large intestines. Viral gastroenteritis is an infection caused by a variety of viruses that results in vomiting or diarrhea. It is often called the "stomach flu," although it is not caused by the influenza viruses.

Common Causative Agent rotaviruses; noroviruses; adenoviruses

How is viral gastroenteritis treated?The most important of treating viral gastroenteritis in children and adults is to prevent severe loss

of fluids (dehydration). This treatment should begin at home. Your physician may give you specific instructions about what kinds of fluid to give. CDC recommends that families with infants and young children keep a supply of oral rehydration solution (ORS) at home at all times and use the solution when diarrhea first occurs in the child. ORS is available at pharmacies without a prescription. Follow the written directions on the ORS package, and use clean or boiled water. Medications, including antibiotics (which have no effect on viruses) and other treatments, should be avoided unless specifically recommended by a physician.

Can viral gastroenteritis be prevented?Persons can reduce their chance of getting infected by frequent handwashing, prompt disinfection

of contaminated surfaces with household chlorine bleach-based cleaners, and prompt washing of soiled articles of clothing. If food or water is thought to be contaminated, it should be avoided. Rotavirus gastroenteritis can also be prevented by vaccines.

Laboratory Management Routine cases of AGE do not require extensive laboratory workup. Stool cultures are indicated in cases of dysentery or where the diagnosis of AGE is unclear. Serum electrolytes should be considered in cases of moderate to severe dehydration, when

thecase is not straightforward, or when IV fluids are required Also consider electrolytes if symptoms of hyernatremia (irritability, doughy skin)Attack of illness

and Healing duration

CLINICAL MANIFESTATION Mean incubation period of 24-48 hour (1-2 days) Mean duration of illness of 12-60 hours (2-3 days)

FLUID MANAGEMENT

Oral rehydration therapy has repeatedly been proven to be as effective as intravenous fluids in treatment of mild to moderate dehydration both outpatient and inpatient.

Some studies have demonstrated decreased ER stays and increased parent satisfaction with ORS therapy over IV therapy. There is no difference, however, in duration of illness or hospitalization rates.

Oral rehydration solutions contain glucose plus electrolytes. Many easily available solutions (e.g. Pedialyte) have 4550 mmol/L of sodium, which is at lower end of that studied. These are best for maintenance fluids, but can be utilized for rehydration in otherwise healthy children.

REHYDRATION PROTOCOLS:

Mild: 50cc/kg of ORS plus replacement over 4 hours** begin with 5cc aliquots q12 min with volumes increasing as tolerated

Moderate: 100cc/kg of ORS plus replacement over 4 hours

As for mild, but should be in supervised setting (ER, office)Severe:

20cc/kg of isotonic IV fluids over one hour Repeat as necessary Continue replacement for stools

MEDICATIONSAntidiarrheals (e.g. loperamide, opiates, bismuth subsalicylate) are not recommended for use in

AGE. Opiates are contraindicated, and the others have limited scientific evidence to outweigh risks)Antiemetics currently antiemetics are not recommended in the treatment of AGE. Though some clinical studies have demonstrated that ondansetron can decrease vomiting and hospitalization.

PROBIOTICSNormally, gut flora (saccharolytic bacteria) ferment dietary carbohydrates that have not been

absorbed. Diarrhea reduces fecal flora. § Probiotics (e.g. Lactobacillus GG) alter the composition of gut flora and assist in restoring normal gut function.More studies are supporting the use of probiotics, specifically Lactobacillus GG, as an adjuvant therapy in AGE.

Common ANTIMICROBIAL AGENTS Cotrimoxazole (first line of Drugs) Ampicillin (injection antibacterial drugs)

Indication: for susceptible bacterial Infection Ceftraixone (Injection antibacterial drugs)

Indication: treatment for Lower bacterial infection

Selected Oral Antibiotics for Infectious Gastroenteritis*Organism Antibiotic Adult Dosage Pediatric Dosage

Vibrio cholerae Ciprofloxacin 1 g once NA

Doxycycline 300 mg single dose 6 mg/kg single dose

TMP/SMX 1 DS tablet bid for 3

days

4–6 mg‡/kg bid for 5 days

Clostridium difficile Metronidazole 250 mg qid or 500

mg tid for 10 days

7.5 mg/kg qid for 10 days

Vancomycin 125–250 mg qid for

10 days

10 mg/kg qid for 10 days

Fidaxomicin 200 mg bid for 10 NA

days

Shigella Ciprofloxacin 500 mg bid for 5

days

NA

TMP/SMX 1 DS tablet bid 4–6 mg‡/kg bid for 5 days

Giardia intestinalis

(lamblia)

Metronidazole 250 mg tid for 5

days

5 mg/kg tid for 5 days

(maximum 750 mg/day)

Nitazoxanide 500 mg bid for 3

days

1–3 yr: 100 mg bid for 3

days

4–11 yr: 200 mg bid for 3

days

≥ 12 yr: 500 mg bid for 3

days

Entamoebahistolytica Metronidazole 750 mg tid for 5–10

days

12–16 mg/kg tid for 10

days (maximum 750

mg/day)

Campylobacter jejuni Azithromycin 500 mg once/day

for 3 days

10 mg/kg once/day for 3

days

Ciprofloxacin 500 mg once/day

for 5 days

NA

*Antibiotics are not indicated in most cases but may be used supportively with IV fluids to treat infections caused by specific organisms.

†This drug should not be given to children aged < 8 yr or to pregnant women.

‡Dose is based on trimethoprim

 component.

§Treatment should be followed by iodoquinol

 10–13 mg/kg tid for 20 days or paromomycin

500 mg potid for 7 days.

DS = double-strength; NA = not applicable; TMP/SMX = trimethoprim/sulfamethoxazole

.

Reference:

Internet:

Case Study about Gastro enteritishttp://www.scribd.com/doc/28394687/acute-gastroenteritis-case-study#downloadhttp://www.scribd.com/doc/8358289/Acute-Gastroenteritis

Manangement and Treatment http://www.virology.uct.ac.za/teachgastro.html

Viral Gastroenteritishttp://www.cdc.gov/ncidod/dvrd/revb/gastro/faq.htm

http://www.merckmanuals.com/professional/gastrointestinal_disorders/gastroenteritis/overview_of_gastroenteritis.html#v893256