Diarrhea (peds)

Causes

Infection

Viral: rotavirus, Norwalk virus, enteroviruses, astroviruses, adenoviruses, caliciviruses

Bacterial: Salmonella, Shigella, Yersinia, Campylobacter, Escherichia coli, Aeromonas hydrophila, Vibrio species, Clostridium difficile, tuberculosis

Parasitic: Giardia lamblia, Entamoeba histolytica, Cryptosporidia

Dietary disturbances

Overfeeding, food allergy, starvation stools

Anatomic abnormalities

Intussusception, Hirschsprung disease, partial obstruction, appendicitis, blind loop syndrome, intestinal lymphangiectasia, short bowel syndrome

Inflammatory bowel disease

Malabsorption or secretory diseases

Cystic fibrosis, celiac disease, disaccharidase deficiency, acrodermatitis enteropathica, secretory neoplasms

Systemic diseases

Immunodeficiency, endocrinopathy (hyperthyroidism, hypoparathyroidism, congenital adrenal hyperplasia)

Miscellaneous

Antibiotic-associated diarrhea, secondary lactase deficiency, irritable colon syndrome, neonatal drug withdrawal, toxins, hemolytic uremic syndrome

Treatment

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	None; severe diarrhea or cholera may benefit from antibiotics

See Also

Dehydration Nausea and Vomiting

Sources

Rosen's, Tintinalli