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Pediatric Emergency Medicine Practice Acute Gastroenteritis — An Update - $30.00

This issue includes 4 AMA PRA Category 1 Credits^TM; 4 ACEP category 1 credits; and 4 AAP Prescribed credits.

Authors

Amandeep Singh, MD
Department of Emergency Medicine, Highland General Hospital, Oakland, CA; Assistant Clinical Professor of Medicine, Department of Emergency Medicine, UC San Francisco, San Francisco, CA

Michelle Fleurat, MD
Resident Physician, Department of Emergency Medicine, Alameda County Medical Center - Highland General Hospital, Oakland, CA

Peer Reviewers

Kenneth T. Kwon, MD, FAAP, FACEP
Director of Pediatric Emergency Medicine, Associate Clinical Professor, University of California, Irvine Medical Center, Orange, CA; Director, Pediatric Emergency Services, Mission Hospital/Children’s Hospital of Orange County at Mission, Mission Viejo, CA

Paula Whiteman, MD, FACEP, FAAP
Attending Physician, Ruth and Harry Roman Emergency Department, Cedars-Sinai Medical Center, Los Angeles, CA; Director of Pediatric Emergency Services, Providence Tarzana Medical Center, Tarzana, CA

Publication Date: July 2010; Volume 7, Number 7

Excerpt from the issue...
You are nearing the end of a busy shift when a nurse comes up to you and says that there is a family with 3 kids in the next room who are all complaining of nausea, vomiting, and diarrhea. As you enter the room, you note an 8-month-old who is being held in her mom’s arms and her 2 older siblings, ages 5 and 7, none of whom appear toxic. Before you begin, the mom interrupts and states that she has just seen her children’s pediatrician and that her doctor sent her to the ED for blood-work and IV fluid rehydration. You briefly contemplate telling the mom that you are the emergency medicine doctor and you will make the decisions in the ED, but you decide that it would be better to first gain her trust by performing an appropriate history and physical examination and then discussing treatment options regarding rehydration.

Gastroenteritis refers to inflammation of the lining of both the stomach and small intestines. The majority of cases are infectious with viral organisms predominating; however, bacterial and parasitic infections can be a specific concern in the appropriate patient. Non-infectious gastrointestinal inflammation may follow certain ingestions (eg, toxic mushroom ingestion, gluten in patients with celiac disease, dairy in lactose sensitive patients), medications (eg, chemotherapeutic agents, non-steroidal anti-inflammatory medications, certain antibiotics), chemical toxins (eg, anticholinergic toxins, heavy metals, plant substances), and malignancy and can be seen in other conditions such as Crohn’s disease and ischemic bowel disease.

Although some acute gastroenteritis syndromes consist predominately of either vomiting or diarrhea, most have an element of both, with additional symptoms being variably present such as anorexia, abdominal pain, and fever. Clinicians should be wary of diagnosing children who present with isolated diarrhea or vomiting as having “viral gastroenteritis” until a thorough evaluation of other causes has been completed. A variety of serious conditions such as appendicitis, bacterial enteritis, diabetic ketoacidosis, pyelonephritis, pneumonia, intussusception, and toxic ingestions can present with symptoms identical to gastroenteritis. A thorough clinical examination, selective application of laboratory testing and diagnostic imaging, and documentation of suitable return precautions will prevent misdiagnoses and unexpected outcomes in these patients. This article will address these issues.