Diarrhea (peds)

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This page is for pediatric patients. For adult patients, see: diarrhea

Background

Gasterointestinal anatomy.
Layers of the Alimentary Canal. The wall of the alimentary canal has four basic tissue layers: the mucosa, submucosa, muscularis, and serosa.
  • 85% of diarrhea is infectious in etiology
    • Viruses cause vast majority of infectious diarrhea
    • Bacterial causes are responsible for most cases of severe diarrhea

Definitions

  • Diarrhea: Increased frequency of defection, usually >3 bowel movements per day
  • Hyperacute: 1-6 hr
  • Acute: less than 3 weeks in duration
  • Gastroenteritis: Diarrhea with nausea and/or vomiting
  • Dysentery: Diarrhea with blood/mucus/pus
  • Invasive = Infectious

Clinical Features

Bristol Stool Chart.

History

Physical Exam

Differential Diagnosis

Infection

Dietary disturbances

  • Overfeeding
  • Food allergy
  • Starvation stools

Anatomic abnormalities

Malabsorption or secretory diseases

  • Cystic fibrosis
  • Celiac disease
  • Disaccharidase deficiency
  • Secretory neoplasms

Systemic diseases

Miscellaneous

Evaluation

Management

General Treatment

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