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

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

Nausea and vomiting

Critical

• ACS/MI
• Boerhaave's
• DKA
• Intracranial hemorrhage
• Ischemic bowel
• Meningitis
• Sepsis

Emergent

• Acute radiation syndrome
• Acute gastric dilation
• Adrenal insufficiency
• Appendicitis
• Bowel obstruction/ileus
• Carbon monoxide poisoning
• Cholecystitis
• CNS tumor
• Electrolyte abnormalities
• Elevated ICP
• Gastric outlet obstruction, gastric volvulus
• Hyperemesis gravidarum
• Medication related
  • Acetaminophen toxicity
  • Aspirin toxicity
  • Digoxin toxicity
  • Theophylline toxicity
  • GLP-1 receptor agonist toxicity
• Pancreatitis
• Peritonitis
• Ruptured viscus
• Testicular torsion/ovarian torsion

Nonemergent

• Acute gastroenteritis
• Biliary colic
• Cannabinoid hyperemesis syndrome
• Chemotherapy
• Cyclic vomiting syndrome
• ETOH
• Gastritis
• Gastroenteritis
• Gastroparesis
• Hepatitis
• Labyrinthitis
• Migraine
• Medication related
  • Disulfiram effect
  • Erythromycin
  • Ibuprofen
  • Ipecac toxicity
• 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 [[Special:MyLanguage/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