Diarrhea (peds): Difference between revisions

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== DDX  ==
==Background==


=== Infection ===
==Clinical Features==


#Viral  
==Differential Diagnosis==
##Rotavirus  
===Infection===
##Norwalk virus  
*Viral  
##Enteroviruses
**[[Rotavirus]]
##Adenoviruses
**[[Norovirus]], Norwalk virus  
#Bacterial  
**[[Enterovirus]]
##Salmonella  
**[[Adenovirus]]
##Shigella  
*Bacterial  
##Yersinia  
**[[Salmonella]]
##Campylobacter  
**[[Shigella]]
##Escherichia coli  
**[[Yersinia]]
##Vibrio species  
**[[Campylobacter]]
##Clostridium difficile  
**[[Escherichia coli]]
##TB  
**[[Vibrio]] species  
#Parasitic  
**[[Clostridium difficile]]
##Giardia  
**[[TB]]
##Entamoeba  
*Parasitic  
##Cryptosporidia
**[[Giardia]]
**[[Entamoeba]]
**[[Cryptosporidium]]


=== Dietary disturbances ===
===Dietary disturbances===
*Overfeeding
*Food [[allergic reaction|allergy]]
*Starvation stools


#Overfeeding
===Anatomic abnormalities===
#Food allergy
*[[Intussusception]]
#Starvation stools
*[[Hirschsprung's disease]]
*Partial [[SBO]]
*[[Appendicitis]]
*Blind loop syndrome
*Intestinal lymphangiectasia
*[[Short bowel syndrome]]


=== Anatomic abnormalities ===
===Malabsorption or secretory diseases===
*[[Cystic fibrosis]]
*Celiac disease
*Disaccharidase deficiency
*Secretory neoplasms


#Intussusception
===Systemic diseases===
#Hirschsprung disease
*Immunodeficiency
#Partial obstruction
*Endocrinopathy
#Appendicitis
**[[Hyperthyroidism]]
#Blind loop syndrome
**[[Hypoparathyroidism]]
#Intestinal lymphangiectasia
**[[Congenital adrenal hyperplasia]]
#Short bowel syndrome


=== Malabsorption or secretory diseases ===
===Miscellaneous===
*[[Inflammatory bowel disease]]
*[[Antibiotic]]-associated diarrhea
*Secondary lactase deficiency
*Irritable colon syndrome
*[[Neonatal abstinence syndrome]]
*[[Toxins]]
*[[Hemolytic uremic syndrome]]


##Cystic fibrosis
==Evaluation==
##Celiac disease
##Disaccharidase deficiency
##Secretory neoplasms


=== Systemic diseases ===
==Management==
===General Treatment===
*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)


#Immunodeficiency
===Diarrheal Pathogens in Children and Specific Therapy===
#Endocrinopathy
##Hyperthyroidism
##Hypoparathyroidism
##Congenital adrenal hyperplasia


=== Miscellaneous ===
{| class="wikitable"
 
#Inflammatory bowel disease
#Antibiotic-associated diarrhea
#Secondary lactase deficiency
#Irritable colon syndrome
#Neonatal drug withdrawal
#Toxins
#Hemolytic uremic syndrome
 
== Treatment  ==
 
=== General Treatment ===
 
If bloody diarrhea, use caution with beginning antibioitics 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).
 
See [[Diarrhea]]
 
=== Diarrheal Pathogens in Children and Specific Therapy ===
 
{| cellpadding="2" border="1"
|-
|-
! align="left" | AGENT  
! align="left" | AGENT  
! align="left" | SPECIFIC THERAPY BEYOND SUPPORTIVE CARE
! align="left" | SPECIFIC THERAPY BEYOND SUPPORTIVE CARE
|-
|-
| 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]]''  
| align="left" | If patient is immunosuppressed, treat as for presumed sepsis
| align="left" | If patient is immunosuppressed, treat as for presumed sepsis
|-
|-
| align="left" | ''Vibrio''  
| align="left" | ''[[Vibrio cholera]]''  
| align="left" | None; severe diarrhea or cholera may benefit from antibiotics
| align="left" | None; severe diarrhea or cholera may benefit from antibiotics
|}
|}


== See Also ==
==See Also==
 
*[[Diarrhea]]  
*[[Diarrhea]]  
*[[Dehydration]]  
*[[Dehydration (peds)]]  
*[[Nausea and Vomiting]]
*[[Nausea and vomiting (peds)]]
 
*[[Acute gastroenteritis (peds)]]
== Source  ==
 
*Rosen's
*Tintinalli


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