Difference between revisions of "Diarrhea (peds)"

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==Differential Diagnosis==
 
==Differential Diagnosis==
=== Infection ===
+
===Infection===
 
*Viral  
 
*Viral  
**Rotavirus  
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**[[Rotavirus]]
**Norwalk virus  
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**[[Norovirus]], Norwalk virus  
**Enteroviruses
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**[[Enterovirus]]
**Adenoviruses
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**[[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
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*Partial [[SBO]]
 
*[[Appendicitis]]  
 
*[[Appendicitis]]  
 
*Blind loop syndrome  
 
*Blind loop syndrome  
 
*Intestinal lymphangiectasia  
 
*Intestinal lymphangiectasia  
*Short bowel syndrome
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*[[Short bowel syndrome]]
  
=== Malabsorption or secretory diseases ===
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===Malabsorption or secretory diseases===
*Cystic fibrosis  
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*[[Cystic fibrosis]]
 
*Celiac disease  
 
*Celiac disease  
 
*Disaccharidase deficiency  
 
*Disaccharidase deficiency  
 
*Secretory neoplasms
 
*Secretory neoplasms
  
=== Systemic diseases ===
+
===Systemic diseases===
 
*Immunodeficiency  
 
*Immunodeficiency  
 
*Endocrinopathy  
 
*Endocrinopathy  
**Hyperthyroidism  
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**[[Hyperthyroidism]]
**Hypoparathyroidism  
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**[[Hypoparathyroidism]]
**Congenital adrenal hyperplasia
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**[[Congenital adrenal hyperplasia]]
  
=== Miscellaneous ===
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===Miscellaneous===
 
*[[Inflammatory bowel disease]]  
 
*[[Inflammatory bowel disease]]  
*Antibiotic-associated diarrhea  
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*[[Antibiotic]]-associated diarrhea  
 
*Secondary lactase deficiency  
 
*Secondary lactase deficiency  
 
*Irritable colon syndrome  
 
*Irritable colon syndrome  
*Neonatal drug withdrawal
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*[[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 (peds)]]  
 
*[[Dehydration (peds)]]  
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*[[Acute gastroenteritis (peds)]]
 
*[[Acute gastroenteritis (peds)]]
  
== References ==
+
==References==
 
+
<references/>
[[Category:Pediatrics]] [[Category:ID]] [[Category:GI]]
+
[[Category:Pediatrics]] [[Category:ID]] [[Category:GI]] [[Category:Symptoms]]

Latest 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