Paediatrics - Queensland Health - Queensland Government
Paediatrics - Queensland Health - Queensland Government
Paediatrics - Queensland Health - Queensland Government
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Gastrointestinal problems<br />
• Bottle fed infant and older child [3]<br />
-- while the infant or child is still vomiting replace formula or usual drinks with<br />
oral rehydration fluid or other clear fluid (volume on previous page)<br />
-- aim to be back to usual formula / diet within 24 hours - do not dilute<br />
-- offer age appropriate foods at meal times even if diarrhoea still present<br />
-- occasionally children will develop lactose intolerance and the diarrhoea will<br />
continue. See Nutrition after gastroenteritis and lactose intolerance<br />
4.2 Moderate dehydration (5 to 10% loss of body weight)<br />
• Consult MO<br />
• Commence rehydration therapy according to MO instructions, usually oral /<br />
nasogastric. Examples of rehydration volumes given below<br />
-- must be managed in appropriately equipped and staffed facility<br />
-- MO will arrange evacuation if required<br />
• Commence a fluid balance sheet immediately<br />
• As well as oral / NGT rehydration, continue breastfeeds / formula and diet as per<br />
mild dehydration<br />
• Monitor child’s observations closely<br />
• Discuss with MO for further decision making after 4 hours<br />
Oral / NGT fluid replacement regime example for moderate dehydration 5 - 10 % [1]<br />
Weight kg<br />
0 - 6 hours<br />
Give oral / NGT fluid replacement<br />
(mL / hr)<br />
7 - 24 hours<br />
(following previous column doses)<br />
Give oral / NGT fluid replacement<br />
(mL / hr)<br />
3 30 20<br />
4 40 30<br />
5 50 35<br />
6 60 40<br />
7 70 45<br />
8 80 50<br />
9 90 55<br />
10 100 60<br />
12 120 65<br />
15 150 70<br />
20 200 85<br />
30 300 90<br />
4.3 Severe dehydration (>10% loss of body weight)<br />
If severe hypovolaemic shock. See Shock<br />
• Consult MO<br />
-- commence rehydration therapy according to MO instructions<br />
- - must be managed in appropriately equipped and staffed facility<br />
- - MO will arrange evacuation<br />
• Monitor conscious state closely and consult MO immediately if altered<br />
• Commence a fluid balance sheet immediately<br />
• Insert IV cannula. If this is unsuccessful after 2 attempts insert intraosseous<br />
cannula and commence infusion using the regime below. MO may take /<br />
request bloods whilst inserting IV / IO for electrolytes, glucose, acid base. See<br />
Intraosseous insertion<br />
Primary Clinical Care Manual 2011 Controlled copy V 1.0 607
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