Diarrhea (peds): Difference between revisions
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[[File:Figure 34 01 10f.png|thumb|Gasterointestinal anatomy.]] | [[File:Figure 34 01 10f.png|thumb|Gasterointestinal anatomy.]] | ||
[[File:Layers of the GI Tract english.png|thumb|Layers of the Alimentary Canal. The wall of the alimentary canal has four basic tissue layers: the mucosa, submucosa, muscularis, and serosa.]] | [[File:Layers of the GI Tract english.png|thumb|Layers of the Alimentary Canal. The wall of the alimentary canal has four basic tissue layers: the mucosa, submucosa, muscularis, and serosa.]] | ||
*85% of diarrhea is infectious in etiology | *85% of diarrhea is infectious in etiology | ||
**[[Viruses]] cause vast majority of infectious diarrhea | **[[Viruses]] cause vast majority of infectious diarrhea | ||
Revision as of 19:53, 6 March 2024
This page is for pediatric patients. For adult patients, see: diarrhea
Background
- 85% of diarrhea is infectious in etiology
- Viruses cause vast majority of infectious diarrhea
- Bacterial causes are responsible for most cases of severe diarrhea
- Foreign travel associated with 80% probability of bacterial diarrhea (see Traveler's Diarrhea)
Definitions
- Diarrhea: Increased frequency of defection, usually >3 bowel movements per day
- Hyperacute: 1-6 hr
- Acute: less than 3 weeks in duration
- Gastroenteritis: Diarrhea with nausea and/or vomiting
- Dysentery: Diarrhea with blood/mucus/pus
- Invasive = Infectious
Clinical Features
Differential Diagnosis
Infection
- Viral
- Rotavirus
- Norovirus, Norwalk virus
- Enterovirus
- Adenovirus
- Bacterial
- Parasitic
Dietary disturbances
- Overfeeding
- Food allergy
- Starvation stools
Anatomic abnormalities
- Intussusception
- Hirschsprung's disease
- Partial SBO
- Appendicitis
- Blind loop syndrome
- Intestinal lymphangiectasia
- Short bowel syndrome
Malabsorption or secretory diseases
- Cystic fibrosis
- Celiac disease
- Disaccharidase deficiency
- Secretory neoplasms
Systemic diseases
- Immunodeficiency
- Endocrinopathy
Miscellaneous
- Inflammatory bowel disease
- Antibiotic-associated diarrhea
- Secondary lactase deficiency
- Irritable colon syndrome
- Neonatal abstinence syndrome
- Toxins
- Hemolytic uremic syndrome
Evaluation
Management
General Treatment
- If bloody diarrhea, use caution with beginning antibiotics in ED before stool culture results
- Some studies demonstrate antibiotic treatment in setting of E.coli O157:H7 leads to increasing risk of hemolytic uremic syndrome (HUS)
Diarrheal Pathogens in Children and Specific Therapy
| AGENT | SPECIFIC THERAPY BEYOND SUPPORTIVE CARE |
|---|---|
| Campylobacter jejuni | Azithromycin 12mg/kg/day PO for 5 days or |
| Erythromycin 30–50mg/kg/day, divided, tid PO for 5–7 days | |
| Clostridium difficile | Metronidazole 30mg/kg/day, divided, QID PO for 7–10 days or |
| Escherichia coli | Azithromycin 12mg/kg/day PO for 5 days or |
| Trimethoprim-sulfamethoxazole 10mg (TMP)/kg/day PO divided BID for 5–7 days | |
| Giardia lamblia | Metronidazole 15mg/kg/day PO, divided, tid for 5 days |
| Salmonella species | In toxic infants <3 mo: Ampicillin 200mg/kg/24 hours q6h for 7–10 days and Gentamicin 5–7.5mg/kg/24 hours q8h IV |
| Shigella species | Azithromycin 12mg/kg/day PO for 5 days or |
| Trimethoprim-sulfamethoxazole 10mg (TMP)/kg/day, divided, BID for 5–7 days if susceptible | |
| Yersinia enterocolitica | If patient is immunosuppressed, treat as for presumed sepsis |
| Vibrio cholera | None; severe diarrhea or cholera may benefit from antibiotics |