Page 39 - 15Diarrhoeaandvomiting

Diarrhoea and vomiting caused by gastroenteritis in children under 5 years

Treat suspected or confirmed shock with a rapid intravenous infusion of 20 ml/kg of 0.9% sodium
chloride solution.
If a child remains shocked after the first rapid intravenous infusion:
• immediately give another rapid intravenous infusion of 20 ml/kg of 0.9% sodium chloride
solution and
• consider possible causes of shock other than dehydration.

Consider consulting a paediatric intensive care specialist if a child remains shocked after the
second rapid intravenous infusion.
When symptoms and/or signs of shock resolve after rapid intravenous infusions, start rehydration
with intravenous fluid therapy
If intravenous fluid therapy is required for rehydration (and the child is not hypernatraemic at
presentation):
• use an isotonic solution such as 0.9% sodium chloride, or 0.9% sodium chloride with 5%
glucose, for fluid deficit replacement and maintenance
• for those who required initial rapid intravenous fluid boluses for suspected or confirmed
shock, add 100 ml/kg for fluid deficit replacement to maintenance fluid requirements, and
monitor the clinical response
• for those who were not shocked at presentation, add 50 ml/kg for fluid deficit replacement to
maintenance fluid requirements, and monitor the clinical response
• measure plasma sodium, potassium, urea, creatinine and glucose at the outset, monitor
regularly, and alter the fluid composition or rate of administration if necessary
• consider providing intravenous potassium supplementation once the plasma potassium level
is known.
If intravenous fluid therapy is required in a child presenting with hypernatraemic dehydration:
• obtain urgent expert advice on fluid management
• use an isotonic solution such as 0.9% sodium chloride, or 0.9% sodium chloride with 5%
glucose, for fluid deficit replacement and maintenance
• replace the fluid deficit slowly – typically over 48 hours
• monitor the plasma sodium frequently, aiming to reduce it at a rate of less than 0.5 mmol/l
per hour.
Attempt early and gradual introduction of oral rehydration therapy during intravenous fluid therapy.
If tolerated, stop intravenous fluids and complete rehydration with oral rehydration therapy.

5.5 Fluid management following dehydration
After rehydration:

• encourage breastfeeding and other milk feeds
• encourage fluid intake
• in children at increased risk of dehydration recurring, consider giving 5 ml/kg of ORS
solution after each large watery stool. These include:
– children younger than 1 year, particularly those younger than 6 months
– infants who were of low birthweight
– children who have passed more than five diarrhoeal stools in the previous 24 hours
– children who have vomited more than twice in the previous 24 hours.
Restart oral rehydration therapy if dehydration recurs after rehydration.

Chapter 6 Nutritional management
During rehydration therapy:
• continue breastfeeding
• do not give solid foods
• in children with red flag symptoms or signs (see Table 4.6), do not give oral fluids other than
ORS solution

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