Paediatrics

Acute Gastroenteritis in a Child (Sample) and WHO Dehydration Assessment

بچوں میں دست اور الٹی

A worked prescription for a 2.5-year-old, 12 kg child with fever, loose stools and vomiting, followed by the first two columns of the WHO dehydration assessment table.

ICD-10: —
Source: OPD handbook pp.199–200
Status: Draft

Not yet reviewed by a clinician. Check doses and brands against current national guidelines before use.

Symptoms

Fever with loose stools and vomiting, 5–6 episodes, unable to keep feeds

Diagnosis

Sample: T 103 °F, pulse 140/min, RR 20/min; mild dehydration; chest clear, abdomen soft
WHO Table 1, Column A (no dehydration): condition well and alert; eyes normal; drinks normally, not thirsty; skin pinch goes back quickly → Treatment Plan A
WHO Table 1, Column B (some dehydration): restless, irritable; eyes sunken; thirsty, drinks eagerly; skin pinch goes back slowly. If the patient has two or more signs in B there is some dehydration → weigh the patient if possible and use Treatment Plan B
Column C (severe dehydration) is cut off at the edge of the scan
Footnotes: a lethargic child is not simply asleep; the skin pinch is less useful in infants or children with marasmus or kwashiorkor

Treatment

Step 1 of 2

1. Emergency treatment (sample)

Pass an IV line
Inj Ringer's lactate 500 mL IV stat
Inj Cipro × 1 in the IV fluid
Inj No-Spa ½ ampoule in the IV fluid
Inj Provas 18 cc IV stat
Inj Flagyl 18 cc IV stat

Prescription

Ringer's lactate (Hartmann's solution)IV crystalloid

Dose500 mL IV stat

Brands Generic / hospital supply

Caution: Monitor for fluid overload, especially in dengue critical-phase recovery

CiprofloxacinFluoroquinolone antibiotic

DoseIn IV fluid

Brand Inj Cipro

Also sold as Novidat, Mercep, Cipro, Ciproxin, Ciprin

DrotaverineAntispasmodic

Dose½ ampoule in IV fluid

Brand Inj No-Spa

Also sold as No-Spa, Nospa, No-Spa Forte

Paracetamol injectionAnalgesic / antipyretic

Dose18 cc IV stat (1.5 cc/kg)

Brand Inj Provas

MetronidazoleAntiprotozoal / antibacterial

Dose18 cc IV stat (1.5 cc/kg)

Brand Inj Flagyl

Step 2 of 2

2. Discharge (sample)

Take ORS after every motion
Light/soft diet; keep the feeding utensils clean; return for any danger sign (partly legible Urdu note)

Prescription

DimenhydrinateAntiemetic

Dose2 tsf, 1+1+1

Brand Syp Gravinat

Also sold as Gravinate, Gravinat

MetronidazoleAntiprotozoal / antibacterial

Dose½+½+½ tsf

Brand Syp Metrogene 200 mg/5 mL

Paracetamol (Acetaminophen)Analgesic / antipyretic

Dose1½+1½+1½ tsf

Brand Syp Febrol 120 mg/5 mL

Also sold as Panadol, Calpol, Febrol, Pedrol, Calpol 6 Plus (250 mg/5 mL)

Caution: Do not exceed 4 g/day in adults or 60 mg/kg/day in children; Avoid in severe liver disease

Oral Rehydration Salts (low-osmolarity WHO ORS)Rehydration

DoseAfter every motion

Brands WHO low-osmolarity ORS sachet

Free ORS is stocked at government facilities and distributed by Lady Health Workers. Many private ORS brands exist; check the sachet states the WHO low-osmolarity formula.

Caution: Mix with the exact volume of clean water stated on the sachet; Discard made-up solution after 24 hours