Diarrhea (peds): Difference between revisions
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{{Peds top}} [[diarrhea]] | |||
==Background== | |||
==Clinical Features== | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
=== Infection === | ===Infection=== | ||
*Viral | *Viral | ||
**Rotavirus | **[[Rotavirus]] | ||
**Norwalk virus | **[[Norovirus]], Norwalk virus | ||
** | **[[Enterovirus]] | ||
** | **[[Adenovirus]] | ||
*Bacterial | *Bacterial | ||
**Salmonella | **[[Salmonella]] | ||
**Shigella | **[[Shigella]] | ||
**Yersinia | **[[Yersinia]] | ||
**Campylobacter | **[[Campylobacter]] | ||
**Escherichia coli | **[[Escherichia coli]] | ||
**Vibrio species | **[[Vibrio]] species | ||
**Clostridium difficile | **[[Clostridium difficile]] | ||
**TB | **[[TB]] | ||
*Parasitic | *Parasitic | ||
**Giardia | **[[Giardia]] | ||
**Entamoeba | **[[Entamoeba]] | ||
** | **[[Cryptosporidium]] | ||
===Dietary disturbances=== | |||
*Overfeeding | *Overfeeding | ||
*Food allergy | *Food [[allergic reaction|allergy]] | ||
*Starvation stools | *Starvation stools | ||
=== Anatomic abnormalities === | ===Anatomic abnormalities=== | ||
*[[Intussusception]] | |||
*Intussusception | *[[Hirschsprung's disease]] | ||
*Hirschsprung disease | *Partial [[SBO]] | ||
*Partial | *[[Appendicitis]] | ||
*Appendicitis | |||
*Blind loop syndrome | *Blind loop syndrome | ||
*Intestinal lymphangiectasia | *Intestinal lymphangiectasia | ||
*Short bowel syndrome | *[[Short bowel syndrome]] | ||
=== Malabsorption or secretory diseases === | ===Malabsorption or secretory diseases=== | ||
*Cystic fibrosis | *[[Cystic fibrosis]] | ||
*Celiac disease | *Celiac disease | ||
*Disaccharidase deficiency | *Disaccharidase deficiency | ||
*Secretory neoplasms | *Secretory neoplasms | ||
=== Systemic diseases === | ===Systemic diseases=== | ||
*Immunodeficiency | *Immunodeficiency | ||
*Endocrinopathy | *Endocrinopathy | ||
**Hyperthyroidism | **[[Hyperthyroidism]] | ||
**Hypoparathyroidism | **[[Hypoparathyroidism]] | ||
**Congenital adrenal hyperplasia | **[[Congenital adrenal hyperplasia]] | ||
*Inflammatory bowel disease | ===Miscellaneous=== | ||
*Antibiotic-associated diarrhea | *[[Inflammatory bowel disease]] | ||
*[[Antibiotic]]-associated diarrhea | |||
*Secondary lactase deficiency | *Secondary lactase deficiency | ||
*Irritable colon syndrome | *Irritable colon syndrome | ||
*Neonatal | *[[Neonatal abstinence syndrome]] | ||
*Toxins | *[[Toxins]] | ||
*Hemolytic uremic syndrome | *[[Hemolytic uremic syndrome]] | ||
== | ==Evaluation== | ||
=== General Treatment === | ==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=== | |||
=== Diarrheal Pathogens in Children and Specific Therapy === | |||
{| class="wikitable" | {| class="wikitable" | ||
| Line 76: | Line 76: | ||
|- | |- | ||
| 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]]'' | ||
| Line 106: | Line 106: | ||
|} | |} | ||
== 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 22:44, 28 November 2019
This page is for pediatric patients. For adult patients, see: diarrhea
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 |