Diarrhea (peds): Difference between revisions

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==Differential Diagnosis==
==Differential Diagnosis==
=== Infection ===
===Infection===
*Viral  
*Viral  
**Rotavirus  
**[[Rotavirus]]
**Norwalk virus  
**[[Norovirus]], Norwalk virus  
**Enteroviruses
**[[Enterovirus]]
**Adenoviruses
**[[Adenovirus]]
*Bacterial  
*Bacterial  
**[[Salmonella]]
**[[Salmonella]]
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**[[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]]


==Diagnosis==
==Evaluation==


== Treatment  ==
==Management==
=== General Treatment ===
===General Treatment===
*If bloody diarrhea, use caution with beginning antibioitics in ED before stool culture results
*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)
*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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|-
|-
| align="left" rowspan="2" | ''[[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''
|-
|-
| align="left" rowspan="2" | ''[[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
|-
|-
| align="left" rowspan="2" | ''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]]''  
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|}
|}


== See Also ==
==See Also==
*[[Diarrhea]]  
*[[Diarrhea]]  
*[[Dehydration]]  
*[[Dehydration (peds)]]  
*[[Nausea and Vomiting]]
*[[Nausea and vomiting (peds)]]
*[[Acute gastroenteritis (peds)]]


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

Revision as of 20:20, 29 September 2019

Background

Clinical Features

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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