Diarrhea, Pediatric

Diarrhea, Pediatric is a topic covered in the 5-Minute Emergency Consult.

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  • One of the most common pediatric complaints; 2nd 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 US 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 days; World Health Organization (WHO) defines case as 3 or more loose or watery stools per day.
    • Chronic if the diarrhea persists for >2 wk


  • 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
        • Methyl xanthines
        • 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's disease, ulcerative colitis
    • Malabsorption syndromes (cystic fibrosis, celiac disease)
    • Irritable bowel syndrome

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