Page 45 - 15Diarrhoeaandvomiting

Diarrhoea and vomiting caused by gastroenteritis in children under 5 years

Diarrhoea and vomiting in children Fluid management

Fluid management

Assess dehydration (see Table 4.6)

Clinical dehydration Clinical shock
No clinical (including suspected or
dehydration
hypernatraemic) confirmed

Preventing dehydration Oral rehydration therapy (ORT) IVT for shock
• Continue • Give 50 ml/kg low osmolarity ORS • Give rapid
5
breastfeeding and solution over 4 hours, plus ORS intravenous infusion
other milk feeds. solution for maintenance, often and of 20 ml/kg 0.9%
sodium chloride
• Encourage fluid in small amounts. solution.
intake. • Continue breastfeeding. • If child remains
• Discourage fruit juices • Consider supplementing with usual fluids shocked repeat
and carbonated (including milk feeds or water, but not infusion and
drinks (especially in fruit juices or carbonated drinks) if a consider other
children at increased child without red flag symptoms or signs causes of shock.
risk of dehydration). (see Table 4.6) refuses to take sufficient • If child remains
• Offer low osmolarity quantities of ORS solution. shocked after a
second infusion,
5
ORS solution as • Consider giving ORS solution via a consider consulting
supplemental fluid nasogastric tube if a child is unable to a paediatric
if at increased risk drink it or vomits persistently. intensive care
of dehydration. • Monitor the response to ORT regularly. specialist.

• Clinical evidence of deterioration and
red flag symptoms/signs (see Table 4.6) or Symptoms/signs
• child vomits ORS solution persistently. of shock resolve

IVT for rehydration
6
• Give an isotonic solution for fluid deficit replacement and maintenance.
• Add 100 ml/kg for children who were initially shocked, or 50 ml/kg for children who were not initially shocked,
to maintenance fluid requirements.
• Monitor the clinical response.
• Measure plasma sodium, potassium, urea, creatinine and glucose at the start, monitor regularly, and change
fluid composition or rate of administration if necessary.
• Consider intravenous potassium supplementation when plasma potassium level is known.
• Continue breastfeeding if possible.
• If hypernatraemic at presentation:
– obtain urgent expert advice on fluid management
6
– use an isotonic solution for fluid deficit replacement and maintenance
– replace the fluid deficit slowly (typically over 48 hours)
– aim to reduce the plasma sodium at less than 0.5 mmol/l per hour.

• During IVT, attempt to introduce ORT early and gradually. If tolerated, stop IVT and complete rehydration with ORT.

5 240–250 mOsm/l. The ‘BNFC’ 2008 edition lists the following products with this composition: Dioralyte, Dioralyte Relief,
Electrolade and Rapolyte.
6 Such as 0.9% sodium chloride, or 0.9% sodium chloride with 5% glucose.

NICE clinical guideline 84 Quick reference guide 9

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