Diarrhea, Pediatric
Basics
Description
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
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
- Viruses: 70–80% of cases:
- 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
- Infectious:
- 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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Citation
Schaider, Jeffrey J., et al., editors. "Diarrhea, Pediatric." 5-Minute Emergency Consult, 6th ed., Lippincott Williams & Wilkins, 2020. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307443/all/Diarrhea_Pediatric.
Diarrhea, Pediatric. In: Schaider JJJ, Barkin RMR, Hayden SRS, et al, eds. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307443/all/Diarrhea_Pediatric. Accessed December 9, 2024.
Diarrhea, Pediatric. (2020). In Schaider, J. J., Barkin, R. M., Hayden, S. R., Wolfe, R. E., Barkin, A. Z., Shayne, P., & Rosen, P. (Eds.), 5-Minute Emergency Consult (6th ed.). Lippincott Williams & Wilkins. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307443/all/Diarrhea_Pediatric
Diarrhea, Pediatric [Internet]. In: Schaider JJJ, Barkin RMR, Hayden SRS, Wolfe RER, Barkin AZA, Shayne PP, Rosen PP, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2020. [cited 2024 December 09]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307443/all/Diarrhea_Pediatric.
* Article titles in AMA citation format should be in sentence-case
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