Diarrhea (peds): Difference between revisions
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== | ==Differential Diagnosis== | ||
=== Infection === | === 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 === | === Dietary disturbances === | ||
*Overfeeding | |||
*Food allergy | |||
*Starvation stools | |||
=== Anatomic abnormalities === | === Anatomic abnormalities === | ||
*Intussusception | |||
*Hirschsprung disease | |||
*Partial obstruction | |||
*Appendicitis | |||
*Blind loop syndrome | |||
*Intestinal lymphangiectasia | |||
*Short bowel syndrome | |||
=== Malabsorption or secretory diseases === | === Malabsorption or secretory diseases === | ||
**Cystic fibrosis | |||
**Celiac disease | |||
**Disaccharidase deficiency | |||
**Secretory neoplasms | |||
=== Systemic diseases === | === Systemic diseases === | ||
*Immunodeficiency | |||
*Endocrinopathy | |||
**Hyperthyroidism | |||
**Hypoparathyroidism | |||
**Congenital adrenal hyperplasia | |||
=== Miscellaneous === | === Miscellaneous === | ||
*Inflammatory bowel disease | |||
*Antibiotic-associated diarrhea | |||
*Secondary lactase deficiency | |||
*Irritable colon syndrome | |||
*Neonatal drug withdrawal | |||
*Toxins | |||
*Hemolytic uremic syndrome | |||
== Treatment == | == Treatment == | ||
Revision as of 08:07, 7 June 2015
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
Source
- Rosen's
- Tintinalli