IDEAL Management

Gastroenteritis is usually an acute and self-limited disease that does not require pharmacological
therapy. The objective of treatment is to replace lost fluids and electrolytes. Oral rehydration is
the preferred method of replacing these losses in children with mild to moderate dehydration.
Metoclopramide and ondansetron however may be helpful in children.

Rehydration

The primary treatment of gastroenteritis in both children and adults is rehydration, i.e.,
replenishment of water and electrolytes lost in the stools. This is preferably achieved by giving
the person oral rehydration therapy (ORT) although intravenous delivery may be required if a
decreased level of consciousness or an ileus is present. Complex-carbohydrate-based Oral
Rehydration Salts (ORS) such as those made from wheat or rice have been found to be superior
to simple sugar-based ORS.

Sugary drinks such as soft drinks and fruit juice are not recommended for gastroenteritis in
children under 5 years of age as they may make the diarrhea worse. Plain water may be used if
specific ORS are unavailable or not palatable.

Diet

It is recommended that breastfed infants continue to be nursed on demand and that formula-fed
infants should continue their usual formula immediately after rehydration with oral rehydration
solutions. Lactose-free or lactose-reduced formulas usually are not necessary. Children receiving
semisolid or solid foods should continue to receive their usual diet during episodes of diarrhea.
Foods high in simple sugars should be avoided because the osmotic load might worsen diarrhea;
therefore substantial amounts of soft drinks, juice, and other high simple sugar foods should be
avoided. The practice of withholding food is not recommended and immediate normal feeding is
encouraged. The BRAT diet (bananas, rice, applesauce, toast and tea) is no longer recommended,
as it contains insufficient nutrients and has no benefit over normal feeding.

Medications

Antiemetics

Antiemetic drugs may be helpful for vomiting in children. Ondansetron has some utility with a
single dose associated with less need for intravenous fluids, fewer hospitalizations, and
decreased vomiting. Metoclopramide also might be helpful. However there was an increased
number of child who returned and were subsequently admitted in those treated with ondansetron.
The intravenous preparation of ondansetron may be given orally.
Antibiotics

Antibiotics are not usually used for gastroenteritis, although they are sometimes used if
symptoms are severe (such as dysentry) or a susceptible bacterial cause is isolated or suspected.
If antibiotics are decided on, a fluoroquinolone or macrolide is often used.

Pseudomembranous colitis, usually caused by antibiotics use, is managed by discontinuing the

causative agent and treating with either metronidazole or vancomycin.

Antimotility agents

Antimotility drugs have a theoretical risk of causing complications, clinical experience however
has shown this to be unlikely. They are thus discouraged in people with bloody diarrhea or
diarrhea complicated by a fever.

Loperamide, an opioid analogue, is commonly used for the symptomatic treatment of

diarrhea.Loperamide is not recommended in children as it may cross the immature blood brain
barrier and cause toxicity.

Bismuth subsalicylate (BSS), an insoluble complex of trivalent bismuth and salicylate, can be
used in mild-moderate cases.

Alternative medicine

Probiotics

Some probiotics have been shown to be beneficial in preventing and treating various forms of
gastroenteritis, Fermented milk products (such as yogurt) also reduce the duration of symptoms.
Reducing inflammation

LAB and supplements have been found to modulate inflammatory and hypersensitivity
responses, an observation thought to be at least in part due to the regulation of cytokine function.[
Clinical studies suggest that they can prevent reoccurrences of inflammatory bowel disease in
adults, as well as improve milk allergies. They are not effective for treating eczema, a persistent
skin inflammation. How probiotics counteract immune system overactivity remains unclear, but
a potential mechanism is desensitization of T lymphocytes, an important component of the
immune system, towards pro-inflammatory stimuli. Experiments into the benefits of probiotic
therapies suggest a range of potentially beneficial medicinal uses for probiotics. For many of the
potential benefits, research is limited and only preliminary results are available. It should be
noted that the effects described are not general effects of probiotics. Recent research on the
molecular biology and genomics of Lactobacillus has focused on the interaction with the
immune system, anti-cancer potential, and potential as a biotherapeutic agent in cases of
antibiotic-associated diarrhoea, travellers' diarrhoea, pediatric diarrhoea, inflammatory bowel
disease and irritable bowel syndrome.

Zinc

The World Health Organization recommends that infants and children receive a dietary
supplement of zinc for up to two weeks after onset of gastroenteritis. A 2009 trial however did
not find any benefit from supplementation.

Zinc is included in most single tablet over-the-counter daily vitamin and mineral supplements.
Zinc also helps speed up the healing process after an injury. Gastroenteritis is strongly attenuated
by ingestion of zinc, and this effect could be due to direct antimicrobial action of the zinc ions in
the gastrointestinal tract, or to the absorption of the zinc and re-release from immune cells (all
granulocytes secrete zinc), or both.

Diagnostic studies

complete blood count (CBC), also known as full blood count (FBC) or full blood exam (FBE)
or blood panel, is a test panel requested by a doctor or other medical professional that gives
information about the cells in a patient's blood. A scientist or lab technician performs the
requested testing and provides the requesting medical professional with the results of the CBC.
The cells that circulate in the bloodstream are generally divided into three types: white blood
cells (leukocytes), red blood cells (erythrocytes), and platelets (thrombocytes). Abnormally high
or low counts may indicate the presence of many forms of disease, and hence blood counts are
amongst the most commonly performed blood tests in medicine, as they can provide an overview
of a patient's general health status. A CBC is routinely performed during annual physical
examinations in some jurisdictions.

Rectal Examination or rectal exam is an internal examination of the rectum such as by a

physician or other healthcare professional. for the diagnosis of appendicitis or other examples of
an acute abdomen (i.e. acute abdominal symptoms indicating a serious underlying disease);The
digital rectal examination (DRE, Latin palpatio per anum or PPA) is a relatively simple
procedure. The patient undresses, then is placed in a position where the anus is accessible (lying
on the side, squatting on the examination table, bent over the examination table, or lying down
with feet in stirrups).
If the patient is lying on their side, the physician will usually have them bring one or both legs up
to their chest. If the patient bends over the examination table, the physician will have them place
their elbows on the table and squat down slightly. If the patient uses the supine position, the
physician will ask the patient to slide down to the end of the examination table until their
buttocks are positioned just beyond the end. The patient then places their feet in the stirrups.

The physician spreads the buttocks apart and will usually examine the external area (anus and
perinium) for any abnormalities such as hemorrhoids, lumps, or rashes. Then, as the patient
strains down, the physician slips a gloved and lubricated finger into the rectum through the anus
and palpates the insides for approximately sixty seconds. The DRE is frequently combined with
an FOBT (fecal occult blood test), which may be useful for diagnosing the etiology of an anemia
and/or confirming a gastrointestinal blee

ELECTROLYTES

Measurement

Measurement of electrolytes is a commonly performed diagnostic procedure, performed via

blood testing with ion selective electrodes or urinalysis by medical technologists. The
interpretation of these values is somewhat meaningless without analysis of the clinical history
and is often impossible without parallel measurement of renal function. Electrolytes measured
most often are sodium and potassium. Chloride levels are rarely measured except for arterial
blood gas interpretation since they are inherently linked to sodium levels. One important test
conducted on urine is the specific gravity test to determine the occurrence of electrolyte
imbalance.

Rehydration

In oral rehydration therapy, electrolyte drinks containing sodium and potassium salts replenish
the body's water and electrolyte levels after dehydration caused by exercise, excessive drinking,
diaphoresis, diarrhea, vomiting, intoxication or starvation. Athletes exercising in extreme
conditions (for three or more hours continuously e.g. marathon or triathlon) who do not consume
electrolytes risk dehydration (or hyponatremia).[1]

Urinalysis is used as a screening and/or diagnostic tool because it can help detect substances or
cellular material in the urine associated with different metabolic and kidney disorders. It is
ordered widely and routinely to detect any abnormalities that require follow up. Often,
substances such as protein or glucose will begin to appear in the urine before patients are aware
that they may have a problem. A routine urinalysis may be done when you are admitted to the
hospital.

Stool Analysis

A stool analysis is a series of tests done on a stool (feces) sample to help diagnose certain
conditions affecting the digestive tract. These conditions can include infection (such as from
parasites, viruses, or bacteria), poor nutrient absorption, or cancer.

For a stool analysis, a stool sample is collected in a clean container and then sent to the
laboratory. Laboratory analysis includes microscopic examination, chemical tests, and
microbiologic tests. The stool will be checked for color, consistency, weight (volume), shape,
odor, and the presence of mucus. The stool may be examined for hidden (occult) blood, fat, meat
fibers, bile, white blood cells, and sugars called reducing substances. The pH of the stool also
may be measured. A stool culture is done to find out if bacteria may be causing an infection.

Help find the cause of symptoms affecting the digestive tract, including prolonged diarrhea,
bloody diarrhea, an increased amount of gas, nausea, vomiting, loss of appetite, bloating,
abdominal pain and cramping, and fever.

Gram staining (or Gram's method) is an empirical method of differentiating bacterial species into two
large groups (Gram-positive and Gram-negative) based on the chemical and physical properties of their
cell walls.[1] The Gram stain is almost always the first step in the identification of a bacterial organism.
While Gram staining is a valuable diagnostic tool in both clinical and research settings, not all bacteria
can be definitively classified by this technique, thus forming Gram variable and Gram indeterminant
groups as well.

A low mean platelet volume means that the platelets are smaller in size compared to the usual.

Abnormally low MPV values correlate primarily with thrombocytopenia when it is due to impaired
production as in aplastic anemia.

A low hemoglobin is referred to as anemia. There are many reasons for anemia. nutritional deficiency
(iron, vitamin B12, folate),