Patient selection: pediatric patient with recent acute gastroenteritis, without signs of dehydration
Parameters:
(1) risk factors for developing dehydration
(2) comorbid conditions
(3) appearance during observation
(4) clinician or parent concern
(5) stool culture indications
High risk for developing dehydration - one or more of the following:
(1) age less than 6 months
(2) vomiting significant volume > 4 times per day
(3) liquid stools > 8 times per day
The patient should:
(1) replace any evidence of fluid deficit with oral rehydration solution (ORS)
(2) consume maintenance fluids
(3) have stool culture taken if there are indications
A patient with all of the following is suitable for early discharge:
(1) low risk for developing dehydration
(2) no significant comorbid conditions
(3) good hydration status during observation period
(4) no reason for concern
A patient who does not meet criteria for early discharge should be observed over 4 to 6 hours.
After the observation period the patient should be considered for admission if:
(1) the hydration status has deteriorated
(2) the clinician is concerned
(3) the caregiver is concerned about taking the child home
After the observation period the patient can be discharged if:
(1) the hydration status has improved
(2) the clinician is not concerned
(3) the caregiver is comfortable about taking the child home
The caregiver of the patient should be educated about how to manage the patient and when to bring the child back.
