See Acute gastroenteritis (peds) for pediatric patients
Background
- Blood diarrhea suggests bacterial etiology
- Viral AGE usually lasts <7d
- Do not dx isolated vomiting as AGE
Causes
Noninvasive AGE
Species |
Onset |
Symptoms |
Transmisison |
Preformed Toxin
|
Viral (norovirus, adenovirus, rotavirus)
|
11-72 hrs
|
- Nausea, vomiting, watery diarrhea
- Mild abd cramps, myalgia
|
- Fecal-oral
- Contaminated food or water
|
No
|
Staph
|
1-6 hrs
|
- Nausea, severe vomiting, diarrhea,
- Mild abd cramping
|
- Previously cooked foods (mayonaise, ham, salads)
|
Yes
|
B. cereus
|
1-6 hrs
|
- Abrupt onset of nausea, vomiting, mild diarrhea
|
- Previously cooked foods (rice, vegetables, dried fruits, meat)
|
Yes
|
C. perfringens
|
8-24 hrs
|
- Nausea, minimal vomiting, watery diarrhea
- Abd cramps
|
- Previously cooked or reheated meats and poultry
|
Yes
|
V. cholerae |
11-72 hrs |
- Explosive rice-water diarrhea
- Vomiting, abd cramps
- Fever
|
- Fecal-oral
- Contaminated food or water
|
No
|
Giardia
|
1-4 wks
|
- Flatus, bloating
- Foul-smelling and fatty stools (steatorrhea)
|
- Fecal-oral
- Contaminated water
|
No
|
Clinical Features
Differential Diagnosis
Diagnosis
- Assess hydration status
- Cap refill, skin turgor, resp rate
- Consider stool labs if:
Management
- Rehydration (PO preferred)
- Antiemetic
- Antibiotics
- Only consider in pts w/ invasive infection
- NOT indicated for E. coli O157:H7
- NOT routinely indicated for salmonella
- Exceptions: SCD, IBD, <3mo
- Azithromycin (able to tolerate PO)
- OR ciprofloxacin
- OR TMP-SMX
- Ceftriaxone (parenteral)
Disposition
- Most can be discharged
- Admit
- Unable to tolerate PO
- Hemodynamic instability
- Significant comorbidities
See Also
References