Gastroenteritis Pathway - Children's Hospital Central California

1.0 .1 cc U IU µg MS TIW QD QID QOD MSO 4 MGSO 4
DRUG SENSITIVITY: WT: kg
ORDERS: GENERIC EQUIVELANT WILL BE DISPENSED UNLESS ORDER SPECIFIES “DO NOT SUBSTITUTE”
General
Admitting physician: ___________________________
Attending physician: ___________________________
Primary service: ¨ Hospitalist ¨ Team A ¨ Team B ¨ __________
Patient Status:
Admission Diagnosis:
Condition:
Code status:
Isolation:
x Admit
x Stable
Gastroenteritis
¨ Full Code or ¨ __________________________
x Contact Precautions
Dietary
Use “Gastro Diet” instructions.
If then, vomiting: If vomiting, attempt small volumes of Pedialyte given frequently, and advance as
tolerated. If oral fluids unsuccessful due to vomiting, give normal saline bolus 20 mL/kg IV over 20-30
minutes if no bolus given in ER. If not vomiting, give formula, breast milk, 2% milk, solid foods or
sugar-free drinks instead of Pedialyte even if patient still has diarrhea.
IVF
RN communication, IVF: Provide IV fluids at 1½ times maintenance for 8 hrs and then Saline lock IV.
Maintenance Fluids (PO plus IV) calculated by 4:2:1 method.
Choice of IV fluids:
• for children under 2 months of age, use D5 ¼ NS + 20 mEq KCl/L
• for children over 2 months of age, use D5 ½ NS + 20 mEq KCl/L
• If admission serum bicarbonate (total CO2) 20, resume use of KCl instead of
K-Acetate. (nurse to call pharmacy)
Notify MD if, Stool: If excessive stool output (>20 mL/kg/day) or patient still vomiting, continue IV
fluids at maintenance.
Once saline locked, do not replace IV if it comes out.
If IV placement fails despite 3 attempts, contact physician to consider placing NG tube instead.
NS bolus option: NS bolus 20 ml/kg 0ml IV one time ONE.
COMMENTS: Dose = 20 mL/kg X 1 if oral fluids unsuccessful due to vomiting.
Give over 20 - 30 minutes, if no bolus given in ER
Medications
Acetaminophen 15 mg/kg (max = 650 mg) PO every 4 hrs PRN T > 38.0º C - 38.9º C or mild pain
(max. dose= 75 mg/kg/day or 4000 mg/day, whichever is less). If patient’s temperature remains above
38.0º C one hour after administration, then give Ibuprofen
Acetaminophen 15 mg/kg (max = 650 mg) PR every 4 hrs PRN T > 38.0º C - 38.9º C or mild pain
(max. dose= 75 mg/kg/day or 4000 mg/day, whichever is less). If patient’s temperature remains above
38.0º C one hour after administration, then give Ibuprofen
Gastroenteritis
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pathway 6/2012
Physician’s Order Sheet
page 1 of 2
Patient Label