Diarrhea (peds): Difference between revisions
 
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== DDX  ==
{{Peds top}} [[diarrhea]]
==Background==
[[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.]]
*85% of diarrhea is infectious in etiology
**[[Viruses]] cause vast majority of infectious diarrhea
**[[Bacteria]]l 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==
[[File:BristolStoolChart.png|thumb|Bristol Stool Chart.]]
===History===
*Possible food poisoning?
**Symptoms occur within 6hr
*Does it resolve (osmotic) or persist (secretory) with fasting?
*Are the stools of smaller volume (large intestine) or larger volume (small intestine)
*[[Fever]] or [[abdominal pain]]? ([[diverticulitis]], [[gastroenteritis]], [[IBD]])
*[[GI bleeding|Bloody or melenic]]?
*Tenesmus? ([[shigella]])
*Malodorous? ([[giardia]])
*Recent travel? ([[Traveler's Diarrhea]])
*Recent antibiotics? ([[C. diff]])
*[[HIV]]/immunocompromised/high risk behaviors?
*Heat intolerance and anxiety? ([[thyrotoxicosis]])
*[[Paresthesias]] or reverse temperature sensation? ([[Ciguatera]])
 
===Physical Exam===
*[[Thyroid]] masses
*Oral ulcers, erythema nodosum, episcleritis, [[anal fissure]] ([[IBD]])
*[[Reactive arthritis]] ([[Arthritis]], [[conjunctivitis]], urethritis)
**Suggests infection with [[salmonella]], [[shigella]], [[campylobacter]], or [[yersinia]]
 
==Differential Diagnosis==
===Infection===
===Infection===
#Viral
*Viral  
##Rotavirus
**[[Rotavirus]]
##Norwalk virus
**[[Norovirus]], Norwalk virus  
##Enteroviruses
**[[Enterovirus]]
##Adenoviruses
**[[Adenovirus]]
#Bacterial
*Bacterial  
##Salmonella
**[[Salmonella]]
##Shigella
**[[Shigella]]
##Yersinia
**[[Yersinia]]
##Campylobacter
**[[Campylobacter]]
##Escherichia coli
**[[Escherichia coli]]
##Vibrio species
**[[Vibrio]] species  
##Clostridium difficile
**[[Clostridium difficile]]
##TB
**[[TB]]
#Parasitic
*Parasitic  
##Giardia
**[[Giardia]]
##Entamoeba
**[[Entamoeba]]
##Cryptosporidia
**[[Cryptosporidium]]
 
===Dietary disturbances===
===Dietary disturbances===
#Overfeeding
*Overfeeding  
#Food allergy
*Food [[allergic reaction|allergy]]
#Starvation stools
*Starvation stools
 
===Anatomic abnormalities===
===Anatomic abnormalities===
#Intussusception
*[[Intussusception]]
#Hirschsprung disease
*[[Hirschsprung's disease]]
#Partial obstruction
*Partial [[SBO]]
#Appendicitis
*[[Appendicitis]]
#Blind loop syndrome
*Blind loop syndrome  
#Intestinal lymphangiectasia
*Intestinal lymphangiectasia  
#Short bowel syndrome
*[[Short bowel syndrome]]
 
===Malabsorption or secretory diseases===
===Malabsorption or secretory diseases===
##Cystic fibrosis
*[[Cystic fibrosis]]
##Celiac disease
*Celiac disease  
##Disaccharidase deficiency
*Disaccharidase deficiency  
##Secretory neoplasms
*Secretory neoplasms
 
===Systemic diseases===
===Systemic diseases===
#Immunodeficiency
*Immunodeficiency  
#Endocrinopathy
*Endocrinopathy  
##Hyperthyroidism
**[[Hyperthyroidism]]
##Hypoparathyroidism
**[[Hypoparathyroidism]]
##Congenital adrenal hyperplasia
**[[Congenital adrenal hyperplasia]]
 
===Miscellaneous===
===Miscellaneous===
#Inflammatory bowel disease
*[[Inflammatory bowel disease]]
#Antibiotic-associated diarrhea
*[[Antibiotic]]-associated diarrhea  
#Secondary lactase deficiency
*Secondary lactase deficiency  
#Irritable colon syndrome
*Irritable colon syndrome  
#Neonatal drug withdrawal
*[[Neonatal abstinence syndrome]]
#Toxins
*[[Toxins]]
#Hemolytic uremic syndrome
*[[Hemolytic uremic syndrome]] (HUS)
 
==Evaluation==


== Treatment ==
==Management==
===General Treatment===
===General Treatment===
See [[Diarrhea]]
*[[Reduced-osmolarity oral rehydration solution]]
*If [[rectal bleeding|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===
===Diarrheal Pathogens in Children and Specific Therapy===
{| border="1" cellpadding="2"
 
{| class="wikitable"
|-
|-
! align="left" | AGENT  
! align="left" | AGENT  
! align="left" | SPECIFIC THERAPY BEYOND SUPPORTIVE CARE
! align="left" | SPECIFIC THERAPY BEYOND SUPPORTIVE CARE
|-
|-
| rowspan="2" align="left" | ''Campylobacter jejuni''  
| align="left" rowspan="2" | ''[[Campylobacter jejuni]]''  
| align="left" | Azithromycin 12 mg/kg/day PO for 5 days ''or''
| align="left" | [[Azithromycin]] 12mg/kg/day PO for 5 days ''or''
|-
|-
| align="left" | Erythromycin 30–50 mg/kg/day, divided, tid PO for 5–7 days
| align="left" | [[Erythromycin]] 30–50mg/kg/day, divided, tid PO for 5–7 days
|-
|-
| align="left" | ''Clostridium difficile''  
| align="left" | ''[[Clostridium difficile]]''  
| align="left" | Metronidazole 30 mg/kg/day, divided, qid PO for 7–10 days ''or''
| align="left" | [[Metronidazole]] 30mg/kg/day, divided, QID PO for 7–10 days ''or''
|-
|-
| rowspan="2" align="left" | ''Escherichia coli''  
| align="left" rowspan="2" | ''[[Escherichia coli]]''  
| align="left" | Azithromycin 12 mg/kg/day PO for 5 days ''or''
| align="left" | [[Azithromycin]] 12mg/kg/day PO for 5 days ''or''
|-
|-
| align="left" | Trimethoprim-sulfamethoxazole 10 mg (TMP)/kg/day PO divided bid for 5–7 days
| align="left" | [[Trimethoprim-sulfamethoxazole]] 10mg (TMP)/kg/day PO divided BID for 5–7 days
|-
|-
| align="left" | ''Giardia'' lamblia  
| align="left" | ''[[Giardia]]'' lamblia  
| align="left" | Metronidazole 15 mg/kg/day PO, divided, tid for 5 days
| align="left" | [[Metronidazole]] 15mg/kg/day PO, divided, tid for 5 days
|-
|-
| align="left" | ''Salmonella'' species  
| align="left" | ''[[Salmonella]]'' species  
| align="left" | ''In toxic infants &lt;3'' ''mo''<nowiki>:</nowiki><br>Ampicillin 200 mg/kg/24 hours q6h for 7–10 days ''and''<br>Gentamicin 5–7.5 mg/kg/24 hours q8h IV
| align="left" | ''In toxic infants <3'' ''mo''<nowiki>:</nowiki><br>[[Ampicillin]] 200mg/kg/24 hours q6h for 7–10 days ''and''<br>[[Gentamicin]] 5–7.5mg/kg/24 hours q8h IV
|-
|-
| rowspan="2" align="left" | ''Shigella'' species  
| align="left" rowspan="2" | ''Shigella'' species  
| align="left" | Azithromycin 12 mg/kg/day PO for 5 days ''or''
| align="left" | [[Azithromycin]] 12mg/kg/day PO for 5 days ''or''
|-
|-
| align="left" | Trimethoprim-sulfamethoxazole 10 mg (TMP)/kg/day, divided, bid for 5–7 days if susceptible
| align="left" | [[Trimethoprim-sulfamethoxazole]] 10mg (TMP)/kg/day, divided, BID for 5–7 days if susceptible
|-
|-
| align="left" | ''Yersinia enterocolitica''  
| align="left" | ''[[Yersinia enterocolitica]]''  
| align="left" | If patient is immunosuppressed, treat as for presumed sepsis
| align="left" | If patient is immunosuppressed, treat as for presumed sepsis
|-
|-
| align="left" | ''Vibrio''  
| align="left" | ''[[Vibrio cholera]]''  
| align="left" | None; severe diarrhea or cholera may benefit from antibiotics
| align="left" | None; severe diarrhea or cholera may benefit from antibiotics
|}
|}


== See Also ==
==See Also==
*[[Diarrhea]]
*[[Diarrhea]]  
*[[Dehydration]]  
*[[Dehydration (peds)]]  
*[[Nausea and Vomiting]]  
*[[Nausea and vomiting (peds)]]
 
*[[Acute gastroenteritis (peds)]]
== Source ==
*Rosen's
*Tintinalli


[[Category:Peds]] [[Category:ID]] [[Category:GI]]
==References==
<references/>
[[Category:Pediatrics]] [[Category:ID]] [[Category:GI]] [[Category:Symptoms]]

Latest revision as of 16:00, 29 January 2025

This page is for pediatric patients. For adult patients, see: diarrhea

Background

Gasterointestinal anatomy.
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
    • Viruses cause vast majority of infectious diarrhea
    • Bacterial causes are responsible for most cases of severe 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

Bristol Stool Chart.

History

Physical Exam

Differential Diagnosis

Infection

Dietary disturbances

  • Overfeeding
  • Food allergy
  • Starvation stools

Anatomic abnormalities

Malabsorption or secretory diseases

  • Cystic fibrosis
  • Celiac disease
  • Disaccharidase deficiency
  • Secretory neoplasms

Systemic diseases

Miscellaneous

Evaluation

Management

General Treatment

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

See Also

References

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