Seminar: Management of pediatric acute gastroenteritis

Clinical classes: Diagnosis and treatment of diarrhea in children, oral and intravenous rehydration, management of metabolic acidosis and electrolyte disturbances.

Time: 4 hours (8:00 AM – 12:00 PM)

Goal

To understand the etiology, clinical manifestations, diagnostic approach, and evidence-based management of acute gastroenteritis in children, with particular emphasis on the recognition and treatment of dehydration, electrolyte imbalances, and acid-base disturbances.

Before the class

Students should revise:

• Gastrointestinal physiology and mechanisms of intestinal fluid and electrolyte transport.
• Fluid and electrolyte balance in infants and children.
• Basic acid-base physiology.
• Common bacterial and viral causes of acute diarrhea.
• Principles of pediatric fluid therapy.

Topics

1. Etiology and epidemiology of acute gastroenteritis

1.1. Viral gastroenteritis: rotavirus, norovirus, enteric adenoviruses, astrovirus.

1.2. Bacterial gastroenteritis: Salmonella, Campylobacter, Shigella, pathogenic Escherichia coli.

1.3. Clinical differences between viral and bacterial gastroenteritis.

1.4. Transmission routes, epidemiology, and prevention.

2. Clinical assessment and differential diagnosis

2.1. Clinical manifestations of acute gastroenteritis in children.

2.2. Assessment of dehydration and its severity.

2.3. Recognition of hypovolemic shock.

2.4. Differential diagnosis of vomiting, diarrhea, and abdominal pain.

2.5. Indications for hospitalization.

3. Diagnostic approach

3.1. Indications for laboratory investigations.

3.2. Interpretation of electrolyte concentrations, blood gases, glucose, and renal function tests.

3.3. Indications for stool microbiology and molecular testing.

4. Treatment

4.1. Oral rehydration therapy (ORT): indications, principles, and practical application.

4.2. Use of oral rehydration solutions.

4.3. Intravenous fluid therapy: indications and selection of fluids.

4.4. Management of metabolic acidosis.

4.5. Management of sodium and potassium disturbances.

4.6. Nutritional management during and after gastroenteritis.

4.7. Indications and contraindications for antimicrobial treatment.

Topics' details

Students should be able to explain or discuss:

• Mechanisms of secretory, osmotic, inflammatory, and malabsorptive diarrhea.
• Why infants and young children are particularly susceptible to dehydration.
• Clinical signs of mild, moderate, and severe dehydration.
• Differences between isotonic, hypotonic, and hypertonic dehydration.
• Clinical manifestations of hypovolemia and shock.
• Mechanisms of metabolic acidosis in acute gastroenteritis.
• Pathophysiology and complications of hypernatremia and hyponatremia.
• How to estimate fluid deficits and calculate maintenance fluid requirements.
• How to plan oral and intravenous rehydration according to clinical severity.
• Risks associated with inappropriate intravenous fluid administration.
• Indications for electrolyte monitoring and reassessment during treatment.
• Indications for antimicrobial therapy in selected bacterial intestinal infections.
• Recognition of complications such as hemolytic uremic syndrome.
• The role of rotavirus vaccination in preventing severe gastroenteritis.

Clinical skills

During clinical classes, students should practice:

• Taking a medical history from a child with vomiting and diarrhea.
• Assessing hydration status and signs of circulatory compromise.
• Interpreting laboratory findings in dehydrated children.
• Preparing an initial management plan for a child with acute gastroenteritis.
• Calculating fluid requirements in clinical case scenarios.