Paeds SAQs · gastroenterology-hepatology-and-nutrition
Acute gastroenteritis and infectious diarrhoea — formative SAQs
Two formative SAQs on acute gastroenteritis and infectious diarrhoea in children: a toddler with watery diarrhoea and some dehydration, testing the clinical grading of dehydration and the design of oral rehydration therapy with low-osmolarity solution, early feeding and zinc; and a child with bloody diarrhoea and fever, testing the recognition of dysentery, the cautious antibiotic decision, and the specific threat of haemolytic uraemic syndrome from Shiga-toxin Escherichia coli.
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SAQ 1 — The toddler with watery diarrhoea (10 marks, 15 minutes)
An 18-month-old boy has two days of frequent watery, non-bloody diarrhoea and vomiting. He is restless and irritable, his eyes look sunken, his mucous membranes are dry, his skin pinch is slow and his capillary refill is prolonged, but he is alert and his peripheries are warm. His nappies have been drier than usual. [1]
a) Using recognised clinical signs, what grade of dehydration does this child have, and which signs support your grade? (3 marks) [3] [4]
b) Describe your rehydration plan, including the type of fluid, the route, the volume and the timeframe, and what you would do if he refuses to drink. (4 marks) [8] [1]
c) Beyond rehydration, outline the feeding advice and the adjunct treatment you would give, and one thing you would specifically avoid. (3 marks) [5] [1]
References7ShowHide
- [1]Guarino A; Ashkenazi S; Gendrel D; et al European Society for Pediatric Gastroenterology, Hepatology, and Nutrition/European Society for Pediatric Infectious Diseases evidence-based guidelines for the management of acute gastroenteritis in children in Europe: update 2014. J Pediatr Gastroenterol Nutr, 2014.PMID 24739189
- [3]Steiner MJ; DeWalt DA; Byerley JS Is this child dehydrated? JAMA, 2004.PMID 15187057
- [4]Bailey B; Gravel J; Goldman RD; et al External validation of the clinical dehydration scale for children with acute gastroenteritis. Acad Emerg Med, 2010.PMID 20624137
- [5]Lazzerini M; Wanzira H Oral zinc for treating diarrhoea in children. Cochrane Database Syst Rev, 2016.PMID 27996088
- [8]Lifschitz C; Kozhevnikov O; Oesterling C; et al Acute gastroenteritis-changes to the recommended original oral rehydrating salts: a review. Front Pediatr, 2023.PMID 38192370
- [11]Mwendera CA; Yilma M; Wairimu C; et al Burden of Shigella and enterotoxigenic Escherichia coli infections among children under 5 years in Ethiopia, Kenya and Malawi: a systematic review and meta-analysis. BMJ Glob Health, 2026.PMID 41771662
- [13]Freedman SB; Williamson-Urquhart S; Plint AC; et al Multidose Ondansetron after Emergency Visits in Children with Gastroenteritis. N Engl J Med, 2025.PMID 40673584