Diarrhea (peds)

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Differential Diagnosis

Infection

  • Viral
    • Rotavirus
    • Norwalk virus
    • Enteroviruses
    • Adenoviruses
  • Bacterial
    • Salmonella
    • Shigella
    • Yersinia
    • Campylobacter
    • Escherichia coli
    • Vibrio species
    • Clostridium difficile
    • TB
  • Parasitic
    • Giardia
    • Entamoeba
    • Cryptosporidia

Dietary disturbances

  • Overfeeding
  • Food allergy
  • Starvation stools

Anatomic abnormalities

  • Intussusception
  • Hirschsprung disease
  • Partial obstruction
  • 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 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

AGENT SPECIFIC THERAPY BEYOND SUPPORTIVE CARE
Campylobacter jejuni Azithromycin 12 mg/kg/day PO for 5 days or
Erythromycin 30–50 mg/kg/day, divided, tid PO for 5–7 days
Clostridium difficile Metronidazole 30 mg/kg/day, divided, qid PO for 7–10 days or
Escherichia coli Azithromycin 12 mg/kg/day PO for 5 days or
Trimethoprim-sulfamethoxazole 10 mg (TMP)/kg/day PO divided bid for 5–7 days
Giardia lamblia Metronidazole 15 mg/kg/day PO, divided, tid for 5 days
Salmonella species In toxic infants <3 mo:
Ampicillin 200 mg/kg/24 hours q6h for 7–10 days and
Gentamicin 5–7.5 mg/kg/24 hours q8h IV
Shigella species Azithromycin 12 mg/kg/day PO for 5 days or
Trimethoprim-sulfamethoxazole 10 mg (TMP)/kg/day, divided, bid for 5–7 days if susceptible
Yersinia enterocolitica If patient is immunosuppressed, treat as for presumed sepsis
Vibrio None; severe diarrhea or cholera may benefit from antibiotics

See Also

References