Urgent Care Management of Acute Gastroenteritis in Pediatric Patients (Pharmacology CME) -
This digital course, available online and as a PDF download, reviews evidence-based recommendations for the diagnosis and management of acute gastroenteritis in pediatric patients presenting to urgent care. Includes 4 AMA PRA Category 1 Credits™. Included as part of the 4 credits, this CME activity is eligible for 1 pharmacology credit and 2 infectious disease credits, subject to your state and institutional requirements. CME expires on 04/15/2025.
The course covers:
The signs and symptoms that indicate a case of acute gastroenteritis (AGE) in a pediatric patient versus a more serious illness that may require transfer to the emergency department
Indications for laboratory testing in pediatric patients with AGE
The appropriate use of antiemetics to increase the chance that oral rehydration will be successful
Oral rehydration strategies for mild-to-moderately dehydrated patients
Evidence-based recommendations for diet and fluid intake for patients who are discharged home, including the latest evidence on the use of probiotics and prebiotics in the treatment of AGE
Publication Date: April 15, 2022
CME Expiration Date: April 15, 2025
CME Accreditation: EB Medicine is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians. This activity has been planned and implemented in accordance with the accreditation requirements and policies of the ACCME.
Credit Designation: EB Medicine designates this enduring material for a maximum of 4 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Specialty CME Credits: Included as part of the 4 credits, this CME activity is eligible for 1 Pharmacology CME credit and 2 Infectious disease CME credits, subject to your state and institutional approval.
AOA Accreditation: Evidence-Based Urgent Care is eligible for 4 Category 2-A or 2-B credit hours per issue by the American Osteopathic Association.
Emily Montgomery, MD, MHPE, FAAP
Director of Education, Division of Urgent Care, Children's Mercy Kansas City, Kansas City, MO; Clinical Assistant Professor, University of Missouri-Kansas City School of Medicine, Kansas City, MO; Clinical Assistant Professor, University of Kansas School of Medicine, Kansas City, KS
KeriAnne Brady, MD, FAAP (Original Author)
Director of Pediatric Emergency Medicine Education, Attending Physician, Department of Emergency Medicine, New York-Presbyterian/Queens; Instructor of Emergency Medicine in Clinical Pediatrics, Weill Cornell Medical College, New York, NY
Michael Gorn, MD
Vice President, PM Pediatrics Texas; Clinical Assistant Professor, Department of Pediatrics, University of Texas Austin Dell Medical School, Austin, TX
Landon A. Jones, MD (Original Peer Reviewer)
Medical Director, Makenna David Pediatric Emergency Center, University of Kentucky, Department of Emergency Medicine, Assistant Professor, Emergency Medicine and Pediatrics, Lexington, KY
Alexander Toledo, DO, PharmD, FAAEM, FAAP (Original Peer Reviewer)
Chief, Section of Pediatric Emergency Medicine, Arizona Children’s Center, Maricopa Medical Center, Clinical Assistant Professor of Child Health and Emergency Medicine, University of Arizona College of Medicine, Phoenix Campus, Phoenix, AZ
Although most cases of acute gastroenteritis require minimal medical intervention, dehydration and hypoglycemia may develop in cases of prolonged vomiting and diarrhea. The mainstay of treatment for patients with mild-to-moderate dehydration with acute gastroenteritis is oral rehydration solution. Antiemetics allow for improved tolerance of oral rehydration solution, and, when used appropriately, can decrease the need for intravenous fluids and hospitalization. This course reviews the common etiologies of acute gastroenteritis, discusses more severe conditions that should be considered in the differential diagnosis, and provides evidence-based recommendations for management of acute gastroenteritis in pediatric patients presenting to urgent care.
CASE 1: An 18-month-old girl who is up to date on her immunizations and has no prior medical history presents with vomiting and diarrhea for the last 3 days…
She initially had multiple episodes of nonbloody, nonbilious emesis that stopped yesterday.
On the second day, she had several large-volume, watery, nonbloody stools. Her parents estimate she has had approximately 10 episodes of diarrhea since yesterday. They are unsure of how many wet diapers because she has had so many episodes of diarrhea.
She has no fever, cough, rhinorrhea, or rash. Her parents report no recent travel, no new animal exposure, and no antibiotic use within the last 6 weeks.
On examination, she is sitting in her mother’s lap, awake and alert, with her eyes open. The girl weighs 12 kg, and her vital signs are: temperature, 37.6°C (99.7°F); heart rate, 165 beats/min; blood pressure, 90/65 mm Hg; respiratory rate, 22 breaths/min; oxygen saturation, 100% on room air.
Although she is crying during the examination, the girl produces no tears. Her mouth is dry and her eyes appear sunken. Her abdomen is soft, non-distended with no tenderness, no masses, and no hepatosplenomegaly. Her capillary refill is 3 seconds. She has watery, yellow-colored stool in her diaper.
You wonder whether you should give this child a dose of ondansetron and attempt oral hydration, or start IV hydration. You consider sending her stool for culture and/or ordering laboratory studies...
CASE 2: A 2-year-old boy is brought to the urgent care by his mother, who states that his illness started with vomiting, approximately 4 episodes, that has now resolved. He has had 10 episodes of watery, nonbloody stools in the last 2 days…
The boy has no past medical history. He attends daycare, and several other children at the daycare center have the same symptoms.
He is drinking well and has normal urine output.
On examination, he is playing with his toy cars while sitting on the exam table. His vital signs are within normal limits. He has moist oral mucosa and normal cardiac and lung examinations. His abdomen is soft, with no tenderness elicited.
You diagnose the boy with acute gastroenteritis and inform his mother that she should continue with aggressive oral hydration. She asks you whether there is any medication you could prescribe that might stop his diarrhea. She also wants to know if there are specific foods he should avoid.
You wonder if you should prescribe an antidiarrheal agent for this child...
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