Acute infectious gastroenteritis red-flag signs
Severe dehydration, inability to keep liquids down, bloody diarrhea, high fever, and frequent emesis are red-flag features that warrant urgent medical evaluation. [1]
Dehydration and perfusion red flags
Red-flag dehydration features include:
- Little or no peeing, very dark urine, and marked thirst. [2]
- Dry mouth or throat, dizziness or lightheadedness, and crying without tears. [2]
- Decreased urination, dry mouth and throat, dizziness when standing, and crying with few or no tears. [3]
- Severe dehydration that may require hospitalization for intravenous fluids. [4]
Gastrointestinal bleeding and neurologic red flags
Red-flag features suggesting complications or alternative diagnoses include:
- Bloody diarrhea. [1]
- Vomiting so frequent that liquids cannot be kept down. [1]
Fever and severe systemic illness red flags
Red-flag systemic features include:
- High fever defined as temperature >102°F. [1]
Management: initial assessment and immediate actions
Rehydration status should be assessed promptly. [5]
- Oral rehydration solution (ORS) should be used first for mild to moderate dehydration. [5]
- Isotonic intravenous fluids should be used for severe dehydration, shock, altered mental status, or failure of ORS therapy, or in ileus. [5]
Management: oral rehydration and antiemetic support
Reduced osmolarity ORS is recommended as first-line therapy for mild to moderate dehydration in acute diarrhea “from any cause,” including mild to moderate dehydration associated with vomiting or severe diarrhea. [5] ORS should be given with nasogastric administration when oral intake is not tolerated and moderate dehydration is present with normal mental status, or when patients are too weak or refuse to drink adequately. [5] Antiemetic and antimotility agents are considered for symptomatic relief once appropriate for clinical severity. [5]
- An antinausea and antiemetic agent (eg, ondansetron) may be given to facilitate tolerance of oral rehydration in adolescents with acute gastroenteritis associated with vomiting, based on a weak recommendation with moderate-quality evidence. [5]
Management: feeding and ongoing losses
Resumption of an age-appropriate usual diet is recommended during or immediately after the rehydration process is completed. [5] Maintenance fluids and replacement of ongoing stool losses should be provided with ORS until diarrhea and vomiting resolve. [5]
Management: indications for diagnostic testing and antimicrobial therapy
Empiric antimicrobial therapy should not be routinely used in acute infectious diarrhea when inflammatory bacterial infection is not suspected. [6]
- Antimicrobial treatment should be modified or discontinued when a clinically plausible organism is identified from diagnostic testing. [6]
Management: disposition criteria
Hospital-level management should be pursued for severe dehydration requiring intravenous fluids. [4] Urgent evaluation should be pursued for severe foodborne illness features including bloody diarrhea, diarrhea >3 days, fever >102°F, frequent vomiting preventing oral intake, and signs of dehydration. [1]