🧒 PaediatricsGastrointestinalStudentInternResident

Acute Gastroenteritis — ORS & Zinc

Also known as: acute diarrhoea · loose motions · diarrhoeal disease

Acute diarrhoea (± vomiting), usually a self-limiting viral illness. The danger is dehydration; low-osmolarity ORS plus zinc are the evidence-based core of treatment.

Source · Reviewed 2026-08-15 · v1.0— AI-assisted draft — verify against the cited guideline before clinical use.

⚕️ Education only — not medical advice. Verify against the latest official guideline and your local protocol; confirm every drug dose against the cited source before clinical use.

Who gets it

All ages, but under-5 children are most vulnerable. Faeco-oral spread via unsafe water/food. Rotavirus and norovirus are common; Shigella causes dysentery; Vibrio cholerae in outbreaks.

Red flags — escalate / refer

Severe dehydration (lethargic/unconscious, sunken eyes, unable to drink, skin pinch goes back very slowly) → IV fluids urgently.
Blood in stool (dysentery), persistent vomiting, high fever, or diarrhoea >14 days → escalate/investigate.
Young infants dehydrate fast — reassess frequently.

Work-up / diagnosis

1Assess and classify dehydration using WHO/IMNCI signs (no / some / severe) — this drives management.
2Usually no lab is needed; do stool examination for dysentery or persistent diarrhoea.
3Weigh the child and check for danger signs and comorbidity (malnutrition).

Management — overview

Classify dehydration → WHO/IMNCI Plan A (none, home care), Plan B (some, supervised ORS), Plan C (severe, IV).
Give low-osmolarity ORS after each loose stool and continue breastfeeding/age-appropriate feeding throughout.
Give zinc to every child with diarrhoea for 14 days — it shortens the episode and prevents recurrence.
Severe dehydration → IV Ringer's lactate per Plan C, then switch to ORS when able to drink.
Antibiotics only for specific indications (dysentery, suspected cholera, confirmed pathogen) — NOT routine. Avoid anti-motility drugs in children.

In-depthFull dosing & advanced protocol

Drug dosing

Low-osmolarity ORS

Prevent/treat dehydration (Plan A/B)

Adult dose: As much as tolerated after each stool
Paediatric: <2 y: 50–100 mL after each loose stool; ≥2 y: 100–200 mL. Plan B: ~75 mL/kg over 4 h
Route: Oral

WHOWHO/UNICEF — the treatment of diarrhoea (ORS + zinc) & IMNCI ↗

Zinc (as sulfate/acetate/gluconate)

All children with diarrhoea

Paediatric: <6 months: 10 mg/day × 14 days; ≥6 months: 20 mg/day × 14 days
Route: Oral

WHOWHO Model List of Essential Medicines (electronic EML) (2025 (24th)) ↗

IV Ringer's lactate (severe dehydration, Plan C)

Severe dehydration / shock

Paediatric: 100 mL/kg over the WHO age-based schedule; reassess frequently
Route: Intravenous

WHOWHO/UNICEF — the treatment of diarrhoea (ORS + zinc) & IMNCI ↗

When antibiotics ARE indicated

Dysentery (blood in stool, likely Shigella): a locally-sensitive agent (e.g. ciprofloxacin or azithromycin) per antibiogram.
Suspected cholera with severe dehydration: aggressive rehydration plus an antibiotic (e.g. doxycycline or azithromycin) per local guidance.
Persistent diarrhoea (>14 days): nutritional management + evaluate for a specific cause.

WHOWHO/UNICEF — the treatment of diarrhoea (ORS + zinc) & IMNCI ↗

Prevention

Rotavirus vaccine, safe water, sanitation, hand-washing and exclusive breastfeeding reduce incidence.

References

Guidelines change. If something here is out of date, tell us — we keep these current.

🚩 Report outdated / suggest update

More protocols

Neonatal SepsisA serious bloodstream infection in the first 28 days of life. The signs are non-specific — treat early and empirically; delay is dangerous.Febrile SeizureA seizure with fever in a young child (6 months–5 years) without CNS infection or another cause. It is usually benign, but exclude serious causes and support the family.BronchiolitisA viral lower-respiratory infection of infants (usually under 2 years, most often RSV) — coryza followed by wheeze, fine crackles and feeding difficulty. Management is supportive.

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👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Low-osmolarity ORS

Zinc (as sulfate/acetate/gluconate)

IV Ringer's lactate (severe dehydration, Plan C)

📈 When antibiotics ARE indicated

📈 Prevention

📚 References

More protocols

👤 Who gets it

🚩 Red flags — escalate / refer

🔎 Work-up / diagnosis

🧭 Management — overview

💊 Drug dosing

Low-osmolarity ORS

Zinc (as sulfate/acetate/gluconate)

IV Ringer's lactate (severe dehydration, Plan C)

📈 When antibiotics ARE indicated

📈 Prevention

📚 References

More protocols

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

When antibiotics ARE indicated

Prevention

References

Who gets it

Red flags — escalate / refer

Work-up / diagnosis

Management — overview

Drug dosing

When antibiotics ARE indicated

Prevention

References