Diarrhea (peds)
Revision as of 08:23, 7 June 2015 by Rossdonaldson1 (talk | contribs) (→Diarrheal Pathogens in Children and Specific Therapy)
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 |