Management of Severe Food Poisoning

Immediate Assessment and Stabilization

The American Academy of Pediatrics and the Centers for Disease Control and Prevention recommend immediate aggressive fluid resuscitation as the priority for patients with profuse sweating, vomiting, and watery diarrhea, as these symptoms can rapidly progress to hypovolemic shock 1
Evaluate hydration status by checking for orthostatic vital signs, skin turgor, dry mucous membranes, decreased urine output, and altered mental status, as recommended by the Infectious Diseases Society of America 2, 1
Assess severity of dehydration, categorized as mild (3-5% deficit), moderate (6-9%), or severe (≥10% with shock), according to the Centers for Disease Control and Prevention 3

The World Health Organization recommends administering oral rehydration solution (ORS) containing 50-90 mEq/L sodium at 50-100 mL/kg over 2-4 hours for patients with mild to moderate dehydration 3, 1
For severe dehydration or shock, the American College of Emergency Physicians recommends initiating intravenous rehydration immediately with isotonic fluids (normal saline or Ringer's lactate) in 20 mL/kg boluses 3, 6, 1
Replace ongoing losses with 10 mL/kg for each watery stool and 2 mL/kg for each vomiting episode, as suggested by the Centers for Disease Control and Prevention 3

The American Academy of Pediatrics recommends considering ondansetron (0.15-0.2 mg/kg, maximum 4 mg) for persistent vomiting to facilitate oral rehydration 6, 1, 5
Antibiotics are not routinely indicated for acute watery diarrhea without specific indications, such as high fever, bloody diarrhea, or symptoms lasting >5 days, as stated by the Centers for Disease Control and Prevention 7, 4, 1

The American College of Emergency Physicians recommends hospital admission for patients with severe dehydration not responding to initial oral rehydration, persistent vomiting, altered mental status, or signs of shock 1, 8
Recheck hydration status after 2-4 hours of rehydration therapy and re-estimate fluid deficit if still dehydrated, as recommended by the Centers for Disease Control and Prevention 3