TREATMENT PROTOCOLS:

MANAGEMENT OF ACUTE UPPER GASTROINTESTINAL BLEEDING:

Stabilize vitals if in shock- Normal saline 20 ml/kg bolus over fifteen minutes- can be repeated till
pulse volume is felt for a maximum of three times

Place a Nasogastric tube and give a stomach wash- tube to be retained to check for ongoing
losses

Check Hemoglobin- transfuse whole blood or packed cells to maintain a hemoglobin of 8 g/dl

If known case of varices/ chronic liver disease/ painless massive upper GI bleed:
1. Start on Octreotide- 1 mcg/kg stat IV followed by infusion at the rate of 1 mcg/kg/hr
2. Upper GI endoscopic therapy for banding/ sclerotherapy within 12- 24 hours
3. Prophylactic Fluoroquinolones if associated cirrhosis

If bleeding associated with upper abdominal pain:

1. Start on Pantoprazole infusion- 80 mg/1.73m2 BSA bolus, then 0.1 mg/1.73 m2 BSA/hr
infusion
2. Upper GI endoscopic hemostasis followed by continued Pantoprazole infusion for 48 hours

MANAGEMENT OF FUNCTIONAL CONSTIPATION:

Toilet training- explain the nature of the disease to the parents

High fibre diet

If disimpaction needed- start on Peglec oral solution 10 ml- 20 ml/kg/hour- continue till child
passes clear watery stools

Syrup Lactulose 1- 2 ml/kg/day given for 4- 6 weeks till child is well toilet trained and has
accustomed to the high fibre diet