Hope Medical Clinic, Ypsilanti, MI, USA.
Am Fam Physician. 2012 Jun 1;85(11):1059-62.
Acute gastroenteritis in children is a major cause of morbidity in the United States. Viral infections, primarily from rotavirus, cause 75 to 90 percent of cases. The remaining infections are largely bacterial, with as many as 10 percent of cases secondary to diarrheagenic Escherichia coli. The history and physical examination of children with gastroenteritis should focus on assessing for the presence and degree of dehydration and determining the underlying etiology. The child's weight during the illness versus posttreatment is often used to evaluate degree of dehydration retrospectively. The three examination signs that best suggest dehydration in children are an abnormal respiratory pattern, abnormal skin turgor, and prolonged capillary refill time, although parental report of the child's history is also helpful in the assessment. In general, measuring serum electrolyte levels usually is unnecessary in children with mild to moderate dehydration. Laboratory tests are recommended only when severe dehydration is suspected; in such cases, intravenous fluids would be warranted. Although it is not necessary to routinely obtain stool cultures, they should be collected if diarrhea is persistent.
儿童急性肠胃炎是美国发病率的主要原因。病毒性感染（主要是轮状病毒）导致 75%至 90%的病例。其余的感染主要是细菌性的，多达 10%的病例继发于致泻性大肠杆菌。肠胃炎患儿的病史和体检应重点评估脱水的存在和严重程度，并确定潜在病因。患儿在患病期间与治疗后的体重通常用于回顾性评估脱水程度。提示儿童脱水的三个最佳检查体征是异常呼吸模式、异常皮肤弹性和毛细血管再充盈时间，尽管父母报告患儿的病史也有助于评估。一般来说，对于轻度至中度脱水的患儿，通常不需要测量血清电解质水平。只有在怀疑严重脱水时才建议进行实验室检查，在这种情况下，需要静脉输液。虽然不必常规进行粪便培养，但如果腹泻持续存在，应采集粪便进行培养。
