Indicated in most acute diarrheal episodes Antibiotic therapy

should be avoided and implemented only in specific situations, guided by stool culture results. Many causes of diarrhea resolve by addressing the underlying cause (eg, discontinuation of a drug).

B. Fluid Replacement. Management of dehydration due to diarrhea requires initial rapid rehydration, replacement of ongoing losses, and provision of maintenance fluid during recovery.

1. Intravenous. Indicated if patient is markedly volume depleted or has accompanying nausea and vomiting. First stage consists of rapid infusion of isotonic saline to expand intravascular volume (eg, 20 mL/kg over 20-60 minutes). Subsequent IV hydration is a combination of replacement of estimated fluid deficit added to regular maintenance needs. This should occur over 24 hours unless child has hypernatremic dehydration, in which case rehydration should occur over 48 hours.

2. Oral. Indicated for patients who are mildly to moderately dehydrated. Ideal oral hydration solutions are high in Na+ (40-90 mEq/L) with appropriate concentrations of glucose (~2%) to facilitate uptake of Na+ and water without causing osmotic diuresis. Initial fluid resuscitation consists of administration of oral hydration solution in a volume equal to estimated fluid deficit (usually 50-100 mL/kg) given over ~4 hours. This is followed by continual administration of oral hydration solution in volumes calculated to satisfy maintenance requirements and ongoing losses. Patients who present with vomiting as well as diarrhea should be given small, frequent sips of oral hydration solution. Despite vomiting, more than 90% of infants will tolerate oral rehydration given in a gradual manner.

C. Diet. Early refeeding is recommended in managing acute gastroenteritis because luminal contents are a known growth factor for enterocytes and help facilitate mucosal repair following injury. Introducing a regular diet within a few hours of rehydration or continuing the diet during diarrhea without dehydration has been shown to shorten duration of disease. Infants and children with more severe diarrhea may require lactose restriction to prevent exacerbating the diarrhea because of transient lactase deficiency resulting from acute gastroenteritis. Avoid heavily sweetened juices and encourage intake of complex carbohydrates such as rice and potatoes.

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