Management of Dysentery and Vomiting in Children

Assessment and Rehydration

• The degree of dehydration in children with dysentery and vomiting should be assessed based on clinical signs including skin turgor, mucous membrane moisture, lethargy, and capillary refill time 1
• Mild dehydration (3-5% fluid deficit) is characterized by sunken eyes, dry mouth, thirst, and normal to slightly decreased skin turgor, according to the MMWR Recommendations and Reports 2
• Moderate dehydration (6-9% fluid deficit) is characterized by previous signs plus tachycardia, irritability/lethargy, and decreased skin turgor, as stated by the MMWR Recommendations and Reports 2
• Severe dehydration (≥10% fluid deficit) is characterized by previous signs plus shock or near shock, and significantly altered mental status, as reported by the MMWR Recommendations and Reports 2
• For mild dehydration, the MMWR Recommendations and Reports suggest administering 50 mL/kg of oral rehydration solution (ORS) over 2-4 hours 2
• For moderate dehydration, the MMWR Recommendations and Reports recommend administering 100 mL/kg of ORS over 2-4 hours 2
• Ongoing losses should be replaced with additional ORS: 10 mL/kg for each watery stool and 2 mL/kg for each episode of vomiting, as advised by the MMWR Recommendations and Reports 2
• For severe dehydration, immediate IV rehydration with boluses (20 mL/kg) of Ringer's lactate or normal saline should be initiated until vital signs normalize, according to the MMWR Recommendations and Reports 2
• Once stabilized, oral rehydration should be used to complete fluid replacement, as recommended by the MMWR Recommendations and Reports 2

Managing Vomiting

• For children with vomiting, small volumes (5 mL) of ORS should be administered every minute using a spoon or syringe under close supervision, as suggested by the MMWR Recommendations and Reports and Praxis Medical Insights 1, 3
• The volume of ORS can be gradually increased as tolerated, according to the MMWR Recommendations and Reports 3
• Simultaneous correction of dehydration often lessens the frequency of vomiting, as reported by the MMWR Recommendations and Reports 3
• Studies show that >90% of children with vomiting can be successfully rehydrated orally when small volumes are administered frequently, as stated by Praxis Medical Insights 1

Nutritional Management

• Breastfed infants should continue nursing on demand, as recommended by the MMWR Recommendations and Reports and Praxis Medical Insights 1, 2
• For bottle-fed infants, full-strength formula should be continued immediately upon rehydration, according to the MMWR Recommendations and Reports 2
• If formula intolerance is suspected, lactose-free or lactose-reduced formulas should be considered, as suggested by the MMWR Recommendations and Reports 2
• For older children on solid foods, their usual diet should be continued during episodes of dysentery and vomiting, as recommended by the MMWR Recommendations and Reports 3
• Recommended foods include starches, cereals, yogurt, fruits, and vegetables, according to the MMWR Recommendations and Reports 3
• Foods high in simple sugars and fats should be avoided, as advised by the MMWR Recommendations and Reports 3

Medication Considerations

• Antibiotics should be considered when dysentery (bloody diarrhea) is present, especially with high fever, as recommended by the MMWR Recommendations and Reports 3
• Antibiotics are also indicated when watery diarrhea lasts >5 days or when stool cultures indicate a specific bacterial pathogen, according to the MMWR Recommendations and Reports 3
• Antiemetics should only be considered after adequate hydration is established, as suggested by Praxis Medical Insights 1
• Ondansetron may be considered for children >4 years with persistent vomiting to improve tolerance of oral rehydration, as recommended by Praxis Medical Insights 1
• Antimotility drugs (e.g., loperamide) should NOT be given to children with acute diarrhea and vomiting, as advised by Praxis Medical Insights 1

Home Management

• Parents should be instructed to offer small, frequent sips of ORS rather than large volumes, as recommended by the MMWR Recommendations and Reports 3
• A 24-hour supply of ORS should be provided to parents of children with diarrhea upon clinic visits, according to the MMWR Recommendations and Reports 3
• Parents should be taught to monitor for signs of worsening dehydration (decreased urine output, lethargy, persistent vomiting), as advised by the MMWR Recommendations and Reports 3

When to Seek Emergency Care

• Bilious vomiting (green color) requires emergency evaluation, as recommended by Praxis Medical Insights 1
• Projectile vomiting that persists requires emergency evaluation, according to Praxis Medical Insights 1
• Signs of severe dehydration not responding to oral rehydration require emergency care, as advised by Praxis Medical Insights 1
• Bloody diarrhea with high fever or signs of toxicity requires emergency evaluation, as recommended by the MMWR Recommendations and Reports 3