Diarrhea (peds)

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Background

Clinical Features

Differential Diagnosis

Infection

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

Evaluation

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)

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