Rotavirus Treatment & Management
- Author: David D Nguyen, MD, FACEP; Chief Editor: Kirsten A Bechtel, MD more...
Prehospital care of affected infants should be directed toward ensuring a secure airway, breathing, identification of circulatory compromise, and maintenance of adequate circulation. Field personnel may not be able to achieve access in the child with a contracted circulatory volume.
Infants who appear significantly dehydrated ideally should have 20 mL/kg isotonic sodium chloride solution or Ringer lactate solution administered en route to the hospital.
Patients who are less severely affected need only monitored transport.
The destination ED should be an ED approved for pediatrics (EDAP) or a pediatric critical care center (PCCC).
Emergency Department Care
After ensuring proper airway and breathing and assessing circulation, identification and treatment of dehydrated infants is the main objective. In many cases, appropriate rehydration may be accomplished using established oral rehydration protocols. Lethargic children require a fingerstick glucose level immediately either by EMS or in the ED.
For severely dehydrated children, vascular access (often via an IO line) is required.
Administer 20 mL/kg boluses until volume is restored. A total requirement of 60-80 mL/kg is not uncommon.
If more than 40 mL/kg is necessary, consider electrolytes, BUN, and creatinine levels.
Maintenance of hydration the key issue for children who are not dehydrated. Selection of an appropriate fluid is crucial. Some data show that administration of a bolus of 5% dextrose in 0.9% saline can help lower the level of serum ketones in dehydrated gastroenteritis patients. A reduction in hospitalization rate, however, was not seen in this study comparing patients who received dextrose in 0.9% saline compared with those receiving 0.9% saline.
Infants who receive hyperosmolar fluids (eg, commercial soft drinks, sports drinks, gelatin) and those who are fed high salt-content solutions (eg, commercial soup, boiled milk) are at risk for significant hypernatremia.
Ideal maintenance beverages for dehydrated infants with viral enteritis are commercial infant solutions such as Pedialyte and Rice-Lyte. These beverages contain a small amount (usually 2-3%) of glucose and the correct balance of sodium and potassium.
Rehydrating infants with these beverages may be particularly difficult within the first 2 days of the illness because vomiting frequently occurs.
If the infant is vomiting, administer small, frequent feedings.
Once vomiting has resolved, the baby may be given a standard soy-based infant formula. This formula provides adequate energy intake for intestinal healing.
Supplemental feedings of oral maintenance solutions may be administered if fluid losses are excessive.
Avoid sports drinks and other hyperosmolar beverages for the reasons previously stated. Similarly, excessive free-water intake may predispose the infant to hyponatremia.
Antiemetics may be considered for children older than 6 months to control emesis.
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