Summary
Definition
Viral gastroenteritis is an infection of the gastrointestinal tract by a virus, usually rotavirus. It is usually self-limiting, but if untreated may result in morbidity and mortality secondary to dehydration, electrolyte imbalance, and metabolic acidosis.[Figure caption and citation for the preceding image starts]: Transmission electron micrograph of intact rotavirus particles, double-shelled. Distinctive rim of radiating capsomeresCDC/Dr Erskine Palmer; used with permission [Citation ends].
History and exam
Key diagnostic factors
- age <5 years
- exposure to people with gastroenteritis
- lack of immunization against rotavirus
- vomiting
- nonbloody diarrhea
- hyperactive bowel sounds
Other diagnostic factors
- abdominal pain
- low-grade fever
- evidence of dehydration
- decreased body weight
- nondistended abdomen
- abdominal tenderness
- mucus in stool
Risk factors
- age <5 years
- poor personal hygiene
- exposure to people with gastroenteritis
- daycare attendance
- winter months
- poverty
- lack of immunization against rotavirus
- lack of breast-feeding
- immunodeficiency
Diagnostic tests
1st tests to order
- clinical exam
Tests to consider
- serum electrolytes, BUN, creatinine
- CBC
- blood cultures
- stool microscopy
- stool culture
- enzyme immunoassay (EIA) for detection of viral antigen
- stool electron microscopy
Treatment algorithm
no dehydration
mild dehydration (<5%)
moderate dehydration (5% to 10%)
severe dehydration (>10%)
Contributors
Authors
Alexander K.C. Leung, MB BS, FRCPC, FRCP, FRCPCH, FAAP
Clinical Professor of Pediatrics
The University of Calgary
Calgary
Alberta
Canada
Disclosures
AKCL is an author of a guideline and a number of references cited in this topic.
Peer reviewers
Saul Greenberg, MD
Associate Professor
Department of Paediatrics
University of Toronto
Ontario
Canada
Disclosures
SG declares that he has no competing interests.
Y.L. Lau, MBCBhB, MD, FRCP, FRCPCH, FRCPS, FHKAM, FHKCPaed
Professor
Faculty of Medicine
University of Hong Kong
Hong Kong
Disclosures
YLL declares that he has no competing interests.
Peer reviewer acknowledgements
BMJ Best Practice topics are updated on a rolling basis in line with developments in evidence and guidance. The peer reviewers listed here have reviewed the content at least once during the history of the topic.
Disclosures
Peer reviewer affiliations and disclosures pertain to the time of the review.
References
Key articles
Leung AK, Kellner JD, Davies HD. Rotavirus gastroenteritis. Adv Ther. 2005 Sep-Oct;22(5):476-87. Abstract
Cortese MM, Parashar UD; Centers for Disease Control and Prevention. Prevention of rotavirus gastroenteritis among infants and children: recommendations of the Advisory Committee on Immunization Practices (ACIP). MMWR Recomm Rep. 2009 Feb 6;58(RR-2):1-25.Full text Abstract
Le Saux N; Canadian Pediatric Society. Position statement: recommendations for the use of rotavirus vaccines in infants. Oct 2018 [internet publication].Full text
Leung A, Prince T; Canadian Paediatric Society. Oral rehydration therapy and early refeeding in the management of childhood gastroenteritis. Paediatr Child Health. 2006 Nov;11(8):527-31.Full text
Carter B, Fedorowicz Z. Antiemetic treatment for acute gastroenteritis in children: an updated Cochrane systematic review with meta-analysis and mixed treatment comparison in a Bayesian framework. BMJ Open. 2012 Jul 19;2(4):e000622.Full text Abstract
Reference articles
A full list of sources referenced in this topic is available to users with access to all of BMJ Best Practice.
Differentials
- Bacterial gastroenteritis
- Protozoal gastroenteritis
- Food poisoning
More DifferentialsGuidelines
- Recommended child and adolescent immunization schedule for ages 18 years or younger, United States, 2024
- Recommendations for the use of rotavirus vaccines in infants
More GuidelinesPatient information
Diarrhea in children
Rotavirus vaccine
More Patient information
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