Diarrhea (peds)

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DDX

Infection

  1. Viral
    1. Rotavirus
    2. Norwalk virus
    3. Enteroviruses
    4. Adenoviruses
  2. Bacterial
    1. Salmonella
    2. Shigella
    3. Yersinia
    4. Campylobacter
    5. Escherichia coli
    6. Vibrio species
    7. Clostridium difficile
    8. TB
  3. Parasitic
    1. Giardia
    2. Entamoeba
    3. Cryptosporidia

Dietary disturbances

  1. Overfeeding
  2. Food allergy
  3. Starvation stools

Anatomic abnormalities

  1. Intussusception
  2. Hirschsprung disease
  3. Partial obstruction
  4. Appendicitis
  5. Blind loop syndrome
  6. Intestinal lymphangiectasia
  7. Short bowel syndrome

Malabsorption or secretory diseases

    1. Cystic fibrosis
    2. Celiac disease
    3. Disaccharidase deficiency
    4. Secretory neoplasms

Systemic diseases

  1. Immunodeficiency
  2. Endocrinopathy
    1. Hyperthyroidism
    2. Hypoparathyroidism
    3. Congenital adrenal hyperplasia

Miscellaneous

  1. Inflammatory bowel disease
  2. Antibiotic-associated diarrhea
  3. Secondary lactase deficiency
  4. Irritable colon syndrome
  5. Neonatal drug withdrawal
  6. Toxins
  7. Hemolytic uremic syndrome
Infection
  Viral: rotavirus, Norwalk virus, enteroviruses, astroviruses, adenoviruses, caliciviruses
  Bacterial: SalmonellaShigellaYersiniaCampylobacterEscherichia coliAeromonas hydrophilaVibrio species, Clostridium difficile, tuberculosis
  Parasitic: Giardia lambliaEntamoeba histolyticaCryptosporidia 
Dietary disturbances
  Overfeeding, food allergy, starvation stools
Anatomic abnormalities
  Intussusception, Hirschsprung disease, partial obstruction, appendicitis, blind loop syndrome, intestinal lymphangiectasia, short bowel syndrome
Inflammatory bowel disease
Malabsorption or secretory diseases
  Cystic fibrosis, celiac disease, disaccharidase deficiency, acrodermatitis enteropathica, secretory neoplasms
Systemic diseases
  Immunodeficiency, endocrinopathy (hyperthyroidism, hypoparathyroidism, congenital adrenal hyperplasia)
Miscellaneous
  Antibiotic-associated diarrhea, secondary lactase deficiency, irritable colon syndrome, neonatal drug withdrawal, toxins, hemolytic uremic syndrome


Treatment

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

Dehydration

Nausea and Vomiting

Sources

Rosen's, Tintinalli