Diarrhea (peds): Difference between revisions
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==Differential Diagnosis== | ==Differential Diagnosis== | ||
===Infection === | ===Infection=== | ||
*Viral | *Viral | ||
**Rotavirus | **Rotavirus | ||
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**[[Cryptosporidia]] | **[[Cryptosporidia]] | ||
===Dietary disturbances === | ===Dietary disturbances=== | ||
*Overfeeding | *Overfeeding | ||
*Food allergy | *Food allergy | ||
*Starvation stools | *Starvation stools | ||
===Anatomic abnormalities === | ===Anatomic abnormalities=== | ||
*[[Intussusception]] | *[[Intussusception]] | ||
*Hirschsprung disease | *Hirschsprung disease | ||
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*Short bowel syndrome | *Short bowel syndrome | ||
===Malabsorption or secretory diseases === | ===Malabsorption or secretory diseases=== | ||
*Cystic fibrosis | *Cystic fibrosis | ||
*Celiac disease | *Celiac disease | ||
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*Secretory neoplasms | *Secretory neoplasms | ||
===Systemic diseases === | ===Systemic diseases=== | ||
*Immunodeficiency | *Immunodeficiency | ||
*Endocrinopathy | *Endocrinopathy | ||
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**Congenital adrenal hyperplasia | **Congenital adrenal hyperplasia | ||
===Miscellaneous === | ===Miscellaneous=== | ||
*[[Inflammatory bowel disease]] | *[[Inflammatory bowel disease]] | ||
*Antibiotic-associated diarrhea | *Antibiotic-associated diarrhea | ||
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==Diagnosis== | ==Diagnosis== | ||
==Treatment | ==Treatment == | ||
===General Treatment === | ===General Treatment=== | ||
*If bloody diarrhea, use caution with beginning antibioitics in ED before stool culture results | *If bloody diarrhea, use caution with beginning antibioitics 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) | *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=== | ||
{| class="wikitable" | {| class="wikitable" | ||
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==See Also | ==See Also == | ||
*[[Diarrhea]] | *[[Diarrhea]] | ||
*[[Dehydration (peds)]] | *[[Dehydration (peds)]] | ||
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*[[Acute gastroenteritis (peds)]] | *[[Acute gastroenteritis (peds)]] | ||
==References | ==References == | ||
[[Category:Pediatrics]] [[Category:ID]] [[Category:GI]] | [[Category:Pediatrics]] [[Category:ID]] [[Category:GI]] | ||
Revision as of 16:57, 6 July 2016
Background
Clinical Features
Differential Diagnosis
Infection
- Viral
- Rotavirus
- Norwalk virus
- Enteroviruses
- Adenoviruses
- Bacterial
- Parasitic
Dietary disturbances
- Overfeeding
- Food allergy
- Starvation stools
Anatomic abnormalities
- Intussusception
- Hirschsprung disease
- Partial obstruction
- 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
- Hyperthyroidism
- Hypoparathyroidism
- Congenital adrenal hyperplasia
Miscellaneous
- Inflammatory bowel disease
- Antibiotic-associated diarrhea
- Secondary lactase deficiency
- Irritable colon syndrome
- Neonatal drug withdrawal
- Toxins
- Hemolytic uremic syndrome
Diagnosis
Treatment
General Treatment
- If bloody diarrhea, use caution with beginning antibioitics 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 12 mg/kg/day PO for 5 days or |
| Erythromycin 30–50 mg/kg/day, divided, tid PO for 5–7 days | |
| Clostridium difficile | Metronidazole 30 mg/kg/day, divided, qid PO for 7–10 days or |
| Escherichia coli | Azithromycin 12 mg/kg/day PO for 5 days or |
| Trimethoprim-sulfamethoxazole 10 mg (TMP)/kg/day PO divided bid for 5–7 days | |
| Giardia lamblia | Metronidazole 15 mg/kg/day PO, divided, tid for 5 days |
| Salmonella species | In toxic infants <3 mo: Ampicillin 200 mg/kg/24 hours q6h for 7–10 days and Gentamicin 5–7.5 mg/kg/24 hours q8h IV |
| Shigella species | Azithromycin 12 mg/kg/day PO for 5 days or |
| Trimethoprim-sulfamethoxazole 10 mg (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 |