Airway and breathing support if altered mental status
Oxygen for hypoxemia
Cardiac monitoring if shock or severe electrolyte concern
IV or IO access if shock or severe dehydration
Isotonic fluid bolus if shock
20 mL per kg
Reassess after each bolus
Glucose check if lethargy or altered mental status
Broad sepsis pathway if toxic with concern for bacterial source
Rehydration
Rehydration strategy
Oral rehydration solution for mild to moderate dehydration
50 mL per kg over 4 hours for mild dehydration
100 mL per kg over 4 hours for moderate dehydration
Additional 10 mL per kg per stool
IV fluids for severe dehydration or failed ORS
Isotonic crystalloid
Transition to deficit replacement and maintenance after stabilization
Hypernatremia precautions
Slow correction planning
Sodium monitoring frequency per protocol
Antiemetic and symptom control
Symptom control options
Ondansetron for vomiting limiting ORS
0.15 mg per kg PO once
Maximum single dose 8 mg
Antidiarrheals avoidance
Loperamide avoidance in young children
Avoid in bloody diarrhea or systemic toxicity
Targeted antimicrobials
Antibiotic decision logic
Avoid empiric antibiotics in suspected Shiga toxin producing E coli
Bloody diarrhea without fever pattern concern
HUS risk consideration
Empiric antibiotics when severe dysentery with systemic toxicity
Local resistance and protocol dependent selection
Stool testing before antibiotics when feasible
Suspected cholera context
Profuse watery diarrhea with travel or outbreak context
Public health notification pathway
Monitoring and reassessment loop
Reassessment loop
Vital signs reassessment after fluids
Mental status reassessment
Urine output monitoring
Ongoing losses replacement planning
Repeat electrolytes when IV rehydration ongoing
Disposition
ICU criteria
ICU level care criteria
Shock requiring ongoing boluses or vasoactive support
Severe altered mental status
Severe electrolyte derangements with ECG changes
Severe acidosis with clinical instability
Inpatient admission criteria
Admission criteria
Severe dehydration
Persistent inability to tolerate oral intake
Failed ED oral rehydration pathway
Suspected HUS
Surgical abdomen concern
Immunocompromised child with significant symptoms
Social concerns limiting safe home care
Observation pathway criteria
Observation criteria
Moderate dehydration improving with ORS
Need for serial reassessment
Pending stool study with significant symptoms
Discharge criteria
Discharge readiness
Normal or improving vital signs
Tolerating oral fluids
Improving hydration exam
Reliable caregiver
Clear return precautions
Follow up plan established
Discharge Instructions
Copy discharge instructions
Home care summary
Most childhood diarrhea is from a stomach infection and improves over a few days
Focus on fluids to prevent dehydration
Fluids and diet
Use oral rehydration solution in small frequent sips
Continue breastfeeding or usual formula
Avoid juice and soda until better
Medications
Use acetaminophen for fever if needed
Do not use anti diarrhea medicines unless told by a clinician
If ondansetron prescribed take only as directed
Follow up
See your primary care clinician within 24 to 48 hours if not improving
Earlier follow up for infants or children with medical complexity
Return to emergency care now
Trouble staying awake
Blue lips or trouble breathing
No urine for 8 hours
Very dry mouth or no tears
Blood in stool
Green vomiting
Severe belly pain
Fever in an infant under 3 months
Worsening weakness or dizziness
References
Guidelines and key sources
Acute gastroenteritis in children guideline ESPGHAN ESPID 2014
Oral rehydration as first line for mild to moderate dehydration
Antiemetic use supports ORS success in selected patients
NICE guideline Diarrhoea and vomiting caused by gastroenteritis under 5 years 2009 updated
Dehydration assessment guidance
Safety net and return precautions emphasis
WHO guideline on diarrhoea treatment in children latest consolidated guidance
ORS standards
Dehydration classification framework
IDSA clinical practice guideline for infectious diarrhea 2017
Stool testing indications
Empiric antibiotics cautions in suspected STEC
CDC clinical overview of norovirus and acute gastroenteritis infection control
Outbreak context considerations
Supportive care emphasis
Project instructions source
Formatting and structure requirements
Evidence labeling expectations
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.