Diarrhea, Pediatric

Basics

Description

  • One of the most common pediatric complaints; second only to respiratory infections in overall disease frequency for ED visits
  • Leading cause of illness and death in children worldwide
  • Acute infectious enteritis (AIE):
    • Vomiting and diarrhea
    • Children <5 yr in the U.S. typically have 2 episodes annually
    • Responsible for ∼10% of all pediatric ED visits and hospital admissions
  • Acute change in the “normal” bowel pattern that leads to increased number or volume of stools and lasts <7 d; World Health Organization (WHO) defines case as 3 or more loose or watery stools per day
    • Chronic if the diarrhea persists for >2 wk
  • From a pathophysiologic point of view, there are two basic mechanisms involved: Osmotic and secretory. Secondary to these mechanisms, alterations in intestinal motility can also occur

Etiology

  • Acute enteritis:
    • Infectious:
      • Viruses: 70–80% of cases:
        • Rotavirus most common
        • Enteric adenovirus
        • Norovirus (foodborne outbreaks)
      • Bacteria: 10–20%:
        • Escherichia coli, Yersinia, Clostridium difficile
        • Salmonella, Shigella, Campylobacter
        • Vibrio
        • Aeromonas
      • Parasites 5%:
        • Cryptosporidiosis (waterborne)
        • Giardia lamblia
    • Noninfectious:
      • Postinfectious
      • Food allergies and intolerance:
        • Cow's milk protein
        • Soy protein
        • Methylxanthines
        • Lactose intolerance
      • Chemotherapy/radiation induced
      • Drug induced:
        • Antibiotics, laxatives, antacids
      • Ingestion of heavy metals – copper, zinc
      • Ingestion of plants – hyacinth, daffodils, amanita species
      • Vitamin deficiency: Niacin, folate
      • Vitamin toxicity: Vitamin C
    • Associated with other infections:
      • Otitis media, UTI, pneumonia, meningitis, appendicitis
  • Chronic diarrhea:
    • Dietary factors: Excessive consumption of sorbitol or fructose from fruit juices
    • Enteric infections in immunocompromised
    • Malnutrition
    • Endocrine: Thyrotoxicosis, pheochromocytoma
    • Inflammatory bowel diseases: Crohn disease, ulcerative colitis
    • Malabsorption syndromes (cystic fibrosis, celiac disease)
    • Irritable bowel syndrome

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