SAQ 160 – Paediatrics – gastroenteritis and dehydration

Question 3. gastroenteritis and dehydration.

a. Assessment findings

• Documented recent weight change using a bare weight where available.
• Delayed capillary refill or mottled skin.
• Reduced skin elasticity or tissue turgor.
• Absent tears, dry mucous membranes, or sunken eyes.
• Abnormal respiration, pulse, conscious state, or urine output.

b. Twin 1 management

• Attempt oral rehydration solution, approximately 10-20 mL/kg over one hour in frequent small amounts.
• If oral intake is unsuccessful or losses continue, commence rapid nasogastric rehydration.
• Consider a single oral dose of ondansetron for significant ongoing vomiting and resume normal feeding or breastfeeding early.

c. Twin 1 justification

• This is moderate dehydration, for which enteral rehydration is as effective as intravenous rehydration.
• Enteral rehydration has fewer complications, shorter admissions, earlier return to diet, and lower cost.

d. Twin 2 management

• Give 0.9% saline 20 mL/kg IV boluses, repeated until shock is corrected.
• Measure blood glucose and treat hypoglycaemia with 10% glucose if present.
• After restoring circulation, provide calculated IV deficit and maintenance fluid, check electrolytes, and correct abnormalities.

e. Twin 2 justification

• Fluid loss greater than 10% represents shock and requires urgent intravenous volume resuscitation.
• After circulation is restored, ongoing deficit, maintenance needs, and electrolyte abnormalities still require correction.