›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
17Disposition/dispo24
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
18Discharge Instructions/di24
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
19References/r18
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
Evidence & Review
Reviewed by SymptomDx Medical Team·Last reviewed
SymptomDx is an educational tool for medical professionals. It does not replace clinical judgment. Verify all clinical data and drug dosages with authoritative sources.