How should I manage a patient with norovirus who presents with severe dehydration?

Management of a patient with norovirus presenting with severe dehydration involves prompt assessment and rehydration therapy.

For severe dehydration, intravenous fluid therapy is indicated, especially if the patient shows signs of shock or cannot tolerate oral fluids.

Start with rapid intravenous infusion of 10 ml/kg of 0.9% sodium chloride solution to treat suspected or confirmed shock.

If shock persists, give a second rapid infusion of 10 ml/kg 0.9% sodium chloride and consider other causes of shock and specialist consultation.

Once shock resolves, continue rehydration with isotonic intravenous fluids such as 0.9% sodium chloride or 0.9% sodium chloride with 5% glucose, replacing the fluid deficit slowly, typically over 48 hours.

Monitor plasma sodium, potassium, urea, creatinine, and glucose regularly, adjusting fluid composition and rate as needed.

Attempt early and gradual introduction of oral rehydration therapy (ORS) during intravenous therapy; if tolerated, stop intravenous fluids and complete rehydration orally.

After rehydration, encourage fluid intake and normal feeding, avoiding fruit juices and carbonated drinks until diarrhoea resolves.

Antibiotics are not routinely indicated for norovirus gastroenteritis.