Diarrhea (peds): Difference between revisions
(Text replacement - "==Treatment==" to "==Management==") |
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*Viral | *Viral | ||
**[[Rotavirus]] | **[[Rotavirus]] | ||
**Norwalk virus | **[[Norovirus]], Norwalk virus | ||
** | **[[Enterovirus]] | ||
**Adenoviruses | **[[Adenoviruses]] | ||
*Bacterial | *Bacterial | ||
**[[Salmonella]] | **[[Salmonella]] | ||
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**[[Giardia]] | **[[Giardia]] | ||
**[[Entamoeba]] | **[[Entamoeba]] | ||
**[[ | **[[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 | *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 | ||
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*Immunodeficiency | *Immunodeficiency | ||
*Endocrinopathy | *Endocrinopathy | ||
**Hyperthyroidism | **[[Hyperthyroidism]] | ||
**Hypoparathyroidism | **[[Hypoparathyroidism]] | ||
**Congenital adrenal hyperplasia | **[[Congenital adrenal hyperplasia]] | ||
===Miscellaneous=== | ===Miscellaneous=== | ||
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*Secondary lactase deficiency | *Secondary lactase deficiency | ||
*Irritable colon syndrome | *Irritable colon syndrome | ||
*Neonatal | *[[Neonatal abstinence syndrome]] | ||
*[[Toxins]] | *[[Toxins]] | ||
*[[Hemolytic uremic syndrome]] | *[[Hemolytic uremic syndrome]] | ||
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==Management== | ==Management== | ||
===General Treatment=== | ===General Treatment=== | ||
*If bloody diarrhea, use caution with beginning | *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) | *Some studies demonstrate antibiotic treatment in setting of ''[[E.coli]]'' O157:H7 leads to increasing risk of [[hemolytic uremic syndrome]] (HUS) | ||
Revision as of 19:04, 21 August 2019
Background
Clinical Features
Differential Diagnosis
Infection
- Viral
- Rotavirus
- Norovirus, Norwalk virus
- Enterovirus
- Adenoviruses
- 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 |