Gastroenteritis aguda: rehidratación oral y tratamiento nutricional. ¿Hacemos lo que debemos hacer?

[Infectious acute gastroenteritis in the emergency department of an urban hospital]

OBJECTIVES

To examine the etiology, clinical, analytical and evolutionary characteristics of gastroenteritis in the pediatric population in the Emergency Department of Dr. Peset University Hospital in Health Care Area 10 in Valencia, Spain, over a 1-year period (2005).

PATIENTS AND METHODS

Children < 15 years of age with acute diarrhea were prospectively enrolled in the Emergency Department. Data were collected through information sheets. Their stools were examined for diarrheagenic bacteria and viruses (rotavirus and adenovirus).

RESULTS

794 episodes of gastroenteritis were recorded. The incidence of rotavirus was 22 %, adenovirus 8 %, Campylobacter jejuni 7 % and Salmonella spp. 4 %. Socioeconomic characteristics were not helpful in differentiating disease due to specific enteropathogens. Ninety per cent cases caused by viruses only affected children under three years of age. Rotavirus gastroenteritis had a marked seasonal pattern (90 % cases in December-February). Among infants < or = 6 months of age rotavirus was less frequent as cause of diarrhea in breast-fed infants than in bottle-fed. Macroscopic blood in stools was reported almost exclusively among patients with a bacterial infection. In 96 % of all cases of diarrhea there was no dehydration, in 2 % it was mild, in 2 % moderate and none severe. Ten of the seventeen cases (59 %) of moderate dehydration were caused by rotavirus. Six percent of all children were hospitalised.

CONCLUSIONS

Rotavirus was significantly more associated with the need for intravenous fluid therapy and hospitalisation than episodes negative for rotavirus. Rotavirus accounted for 3 % of hospitalisations in infants aged 1 month-2 years.

[Oral rehydration in pediatric emergencies. A Spanish survey]

OBJECTIVES

To analyze the approach of emergency pediatricians to acute dehydration and their theoretical knowledge of oral rehydration, to identify the situations in which they believe oral rehydration to be indicated and its use in daily practice, as well as to determine the disadvantages of oral solutions in emergencies.

MATERIAL AND METHOD

We designed a survey, adapted from several similar studies, to evaluate theoretical and practical features of rehydration. The survey was applied in 23 emergency facilities in Spain.

RESULTS

Two-hundred ninety questionnaires were included. A total of 59.3 % of the emergency pediatricians surveyed frequently used oral rehydration in acute dehydration and 10.3 % never used it. All (100 %) used it in mild dehydration (79.3 % if it was associated with vomiting), 70.3 % used it in moderate dehydration with vomiting and 22.8 % used it if it was associated with moderate diarrhea. The main disadvantages of oral rehydration were the number of visits (34.2 %), lack of space (16.6 %) and family distrust (16.2 %). Oral rehydration was used by 64.1 % of emergency pediatricians in children of all age groups and by 17.44 % only in children older than 3 months. A few (3.8 %) believed vomiting to be a contraindication; 26.9 % sometimes used an antiemetic drug and 73.8 % used a nasogastric tube to improve tolerance in the case of vomiting.

CONCLUSIONS

Oral rehydration is widely accepted, but knowledge of its indications and techniques for application could be improved. Its main contraindications are vomiting and/or moderate dehydration; in the case of the emergency infrastructure, its main disadvantage is lack of time and workload. A nasogastric tube is a useful option to avoid an intravenous line. Guidelines for the use of oral rehydration that would reduce obstacles such as lack of time and family distrust should be developed.