Rotavirus
Background
- Leading cause of acute gastroenteritis worldwide
- 95% of children in US have had rotavirus by age 5
- Fecal-oral transmission
- Seasonal: more cases in late winter/early spring
- Vaccination of infants recommended by CDC[1]
Clinical Features
- Low grade fever
- Nausea/Vomiting (typically worse in the first 1-2 days)
- Diarrhea, watery, copious
- Rare complications:
- Hepatitis
- Pneumonitis
- Encephalopathy
Differential Diagnosis
Emergent
- Acute radiation syndrome
- Acute gastric dilation
- Acetaminophen toxicity
- Adrenal insufficiency
- Appendicitis
- Aspirin toxicity
- Bowel obstruction/ileus
- Carbon monoxide poisoning
- Cholecystitis
- CNS tumor
- Digoxin toxicity
- Electrolyte abnormalities
- Elevated ICP
- Gastric outlet obstruction, gastric volvulus
- Hyperemesis gravidarum
- Pancreatitis
- Peritonitis
- Ruptured viscus
- Testicular torsion/ovarian torsion
- Theophylline toxicity
Nonemergent
- Acute gastroenteritis
- Biliary colic
- Cannabinoid hyperemesis syndrome
- Chemotherapy
- Disulfiram effect
- Erythromycin
- ETOH
- Gastritis
- Gastroenteritis
- Gastroparesis
- Hepatitis
- Ibuprofen
- Ipecac toxicity
- Labyrinthitis
- Migraine
- Motion sickness
- Narcotic withdrawal
- Thyroid
- Pregnancy
- Peptic ulcer disease
- Renal colic
- UTI
Evaluation
- Diagnosis usually clinical
- Assess hydration status
- Cap refill, skin turgor, respiratory rate
- Pediatric signs of dehydration: prolonged cap refill, dry mucous membranes, no tears, abnormal overall appearance
- Consider stool labs if:
- >10 stools in previous 24hr
- Travel to high-risk country
- Bloody stool
- Persistent [[diarrhea[[
Management
- Rehydration (PO preferred, especially in children)
- 30mL(1oz)/kg/hr
- Antiemetics (e.g. Ondansetron 0.15mg/kg/dose IV/PO)
Disposition
- Most can be discharged
- Admit
- Unable to tolerate PO
- Hemodynamic instability
- Significant comorbidities
See Also
- Nausea and Vomiting
- Acute gastroenteritis (peds)
- Acute gastroenteritis
- Dehydration
- Acute diarrhea
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