Paediatrics - Queensland Health - Queensland Government

Gastrointestinal problems
Fluid resuscitation regime for severe dehydration
is based on 10% dehydration (person weighs 10% less than their usual weight)
Initial treatment
• 20 mL / kg
• Reassess
• Give second bolus of 20 mL / kg if still shocked
• Ongoing fluids as discussed with MO
• Re-hydrate / resuscitate severely dehydrated child with normal saline or IV Hartmann’s
solution only [1]
• Contact MO for ongoing fluid orders
• Common IV fluids used in children for ongoing maintenance or replacement include
normal saline or normal saline + 5% glucose [1]
Arrangements should be made to transfer child to a paediatric centre. Ongoing fluid input
should be managed in consultation with a Paediatrician
5. Follow up
Evacuation / hospitalisation of children with moderate (if indicated) or severe
dehydration
Children with mild dehydration i.e. < 5% and no clinical signs review in 24 hours
or earlier if parent / carer is concerned that child is worse
Inform the carer that bowel actions may not return to normal for 2 weeks but a
child with continuing watery diarrhoea should be reviewed by a MO
Children with watery diarrhoea lasting longer than 2 - 3 days should have bloods
taken for electrolytes, babies may require this earlier
Reassurance, education and advice concerning hand washing, personal hygiene,
avoiding food preparation, and public swimming pools until diarrhoea has settled
Place child on care plan with individualised review and weighs according to
severity and family situation
If diarrhoea continues beyond 10 days. See Child with chronic diarrhoea flow
chart
Alert other parents of young children in the community of current gastrointestinal
illness and the need to present early to clinic if their child displays any gastro-
intestinal symptoms
Advise parent / carer(s) [1]
• Use methods to help children drink e.g. cup, iceblock, bottle, syringe
• Do not give medicines to reduce vomiting and diarrhoea. They do not work and may
be harmful
• Your baby or child is infectious so wash your hands well with soap and warm water,
particularly before feeding and after changing nappies
• Keep your child away from other children as much as possible until the diarrhoea
has stopped
• Return to clinic if:
-- child is not drinking and still has vomiting and diarrhoea
-- child is vomiting frequently and seems unable to keep any fluids down
-- child is dehydrated e.g. not passing urine (< 3 wet nappies), is pale and has lost
weight, sunken eyes, cold hands and feet, or is hard to wake up
-- if your child has a bad stomach pain
-- if there is any blood in the faeces
-- if there is any green vomit, or you are worried for any other reason
608
Controlled copy V1.0
Primary Clinical Care Manual 2011