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Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Medical Editor:

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, Chief Medical Editor

Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.

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The treatment of gastroenteritis is aimed at hydration and home remedies that address keeping fluid in the body are key to recovery.

Since most causes of gastroenteritis are due to viruses, replacing the fluid lost because of vomiting and diarrhea allows the body to recuperate and fight the infection. Dehydration can also intensify the symptoms of nausea and vomiting. The critical step is replacing fluids when the affected individual is nauseous and doesn't want to drink (hydrate). This is especially difficult with infants and children. Small frequent offerings of clear fluids, sometimes only a mouthful at a time, may be enough to replenish the body's fluid stores and prevent an admission to the hospital for intravenous (IV) fluid administration.

In general, clear fluids (anything you can see through), may be tolerated in small amounts. Think of it as adding just an ounce or less to the saliva that the patient is already swallowing. However, giving too much fluid at one time may cause increased nausea due to a distended stomach, which causes additional irritation.

Clear fluids do not include carbonated beverages but colas or ginger ale with the fizz gone are often well tolerated. Coke syrup may also be helpful in settling the stomach.

Jello and popsicles may be "solid food" alternatives to clear fluids in children who aren't interested in clear fluids.

Oral rehydration therapy using balanced electrolyte solutions such as Pedialyte or Gatorade/Powerade may be all that is needed to replenish the fluid supply in an infant or child. Plain water is not recommended because it can dilute the electrolytes in the body and cause complications such as seizures due to low sodium.

The key to oral rehydration is small frequent feedings. If offered free access to a bottle, infants especially may drink quickly to quench their thirst and then vomit. Instead it may be best to limit the amount of fluid given at one time. There are a variety of regimens that are used and they follow a basic format:

• Offer 1/3 of an ounce (5 to 10 cc) of fluid at one time. Wait 5 to 10 minutes then repeat.
• If this amount is tolerated without vomiting, increase the amount of fluid to 2/3 of an ounce (10 to 20 cc). Wait and repeat.
• If tolerated, increase the fluid offered to 1 ounce (30 cc) at a time.
• If vomiting occurs, go back to the 1/3 of an ounce (5 to 10 cc) and restart.
• Once the child is tolerating significant fluids by mouth, a more solid diet can be offered.

The important thing to remember is that the goal is to provide fluid to the child and not necessarily calories. In the short term, hydration is more important than nutrition.

For infants and children, fluid status can be monitored by

• whether they are urinating,
• if they have saliva in their mouths,
• tears in their eyes, and
• sweat in their armpits or groin.

If the child's baseline weight is known, dehydration can be measured by comparing weight.

Medical care should be accessed immediately, if the child is listless, floppy or does not seem to be acting normal.

Although adults and adolescents have a larger electrolyte reserve than children, electrolyte imbalance and dehydration may still occur as fluid is lost through vomiting and diarrhea. Severe symptoms and dehydration usually develop as complications of medication use or chronic diseases such as diabetes or kidney failure; however, symptoms may occur in healthy people.

• Clear fluids are appropriate for the first 24 hours to maintain adequate hydration.
• After 24 hours of fluid without vomiting, begin a soft-bland solid diet such as the BRAT diet (bananas, rice, apples, toast) and then progress the diet to other foods as tolerated.

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