Diarrhea (peds): Difference between revisions
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== | ==Background== | ||
== | ==Clinical Features== | ||
==Differential Diagnosis== | |||
===Infection=== | |||
*Viral | |||
**[[Rotavirus]] | |||
**[[Norovirus]], Norwalk virus | |||
**[[Enterovirus]] | |||
**[[Adenovirus]] | |||
*Bacterial | |||
**[[Salmonella]] | |||
**[[Shigella]] | |||
**[[Yersinia]] | |||
**[[Campylobacter]] | |||
**[[Escherichia coli]] | |||
**[[Vibrio]] species | |||
**[[Clostridium difficile]] | |||
**[[TB]] | |||
*Parasitic | |||
**[[Giardia]] | |||
**[[Entamoeba]] | |||
**[[Cryptosporidium]] | |||
=== Dietary disturbances === | ===Dietary disturbances=== | ||
*Overfeeding | |||
*Food [[allergic reaction|allergy]] | |||
*Starvation stools | |||
===Anatomic abnormalities=== | |||
*[[Intussusception]] | |||
*[[Hirschsprung's disease]] | |||
*Partial [[SBO]] | |||
*[[Appendicitis]] | |||
*Blind loop syndrome | |||
*Intestinal lymphangiectasia | |||
*[[Short bowel syndrome]] | |||
=== | ===Malabsorption or secretory diseases=== | ||
*[[Cystic fibrosis]] | |||
*Celiac disease | |||
*Disaccharidase deficiency | |||
*Secretory neoplasms | |||
===Systemic diseases=== | |||
*Immunodeficiency | |||
*Endocrinopathy | |||
**[[Hyperthyroidism]] | |||
**[[Hypoparathyroidism]] | |||
**[[Congenital adrenal hyperplasia]] | |||
=== | ===Miscellaneous=== | ||
*[[Inflammatory bowel disease]] | |||
*[[Antibiotic]]-associated diarrhea | |||
*Secondary lactase deficiency | |||
*Irritable colon syndrome | |||
*[[Neonatal abstinence syndrome]] | |||
*[[Toxins]] | |||
*[[Hemolytic uremic syndrome]] | |||
==Evaluation== | |||
=== | ==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) | |||
===Diarrheal Pathogens in Children and Specific Therapy=== | |||
{| class="wikitable" | |||
{| | |||
|- | |- | ||
! 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 | | align="left" | [[Azithromycin]] 12mg/kg/day PO for 5 days ''or'' | ||
|- | |- | ||
| align="left" | Erythromycin | | 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 | | 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 | | align="left" | [[Azithromycin]] 12mg/kg/day PO for 5 days ''or'' | ||
|- | |- | ||
| align="left" | Trimethoprim-sulfamethoxazole | | 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 | | 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 | | 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 | | align="left" | [[Azithromycin]] 12mg/kg/day PO for 5 days ''or'' | ||
|- | |- | ||
| align="left" | Trimethoprim-sulfamethoxazole | | 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 | *[[Nausea and vomiting (peds)]] | ||
*[[Acute gastroenteritis (peds)]] | |||
* | |||
[[Category: | ==References== | ||
<references/> | |||
[[Category:Pediatrics]] [[Category:ID]] [[Category:GI]] [[Category:Symptoms]] |
Revision as of 20:20, 29 September 2019
Background
Clinical Features
Differential Diagnosis
Infection
- Viral
- Rotavirus
- Norovirus, Norwalk virus
- Enterovirus
- Adenovirus
- Bacterial
- Parasitic
Dietary disturbances
- Overfeeding
- Food allergy
- Starvation stools
Anatomic abnormalities
- Intussusception
- Hirschsprung's disease
- Partial SBO
- Appendicitis
- Blind loop syndrome
- Intestinal lymphangiectasia
- Short bowel syndrome
Malabsorption or secretory diseases
- Cystic fibrosis
- Celiac disease
- Disaccharidase deficiency
- Secretory neoplasms
Systemic diseases
- Immunodeficiency
- Endocrinopathy
Miscellaneous
- Inflammatory bowel disease
- Antibiotic-associated diarrhea
- Secondary lactase deficiency
- Irritable colon syndrome
- Neonatal abstinence syndrome
- Toxins
- Hemolytic uremic syndrome
Evaluation
Management
General Treatment
- If 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)
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 |