9.2 Diarrhea

Question 1

Acute Diarrhea

Answer 1

• Sudden change in frequency and consistency of stools
• Usually caused by infection (viral, bacterial, parasitic)
• Can be a side-effect of antibiotics or laxatives
• MUST RESOLVE WITHIN 14 DAYS TO BE CONSIDERED ACUTE

Question 2

Chronic Diarrhea

Answer 2

• Changes in stool frequency and increased water content FOR LONGER THAN 14 DAYS

Causes
- Due to some sort of disease (malabsorption syndrome, food allergies, immunodeficiency, lactose intolerance, chronic nonspecific diarrhea)

Question 3

Chronic Non-Specific Diarrhea (CNSD)

Answer 3

• “Toddler Diarrhea”
• Chronic diarrhea that does not have an identified cause
• Sometimes undigested food can be seen in the stool
• May be caused by poor nutrition, food sensitivities, overuse of fruit juice, artificial sweeteners such as sorbitol, xylitol, mannitol.
• Does not affect child development, no infection, no blood in stool.

Treatment
- Steer parents away from foods high in artificial sweeteners such as sugar free gum, soda, certain fruits.

Question 4

Rotavirus

Answer 4

• Most common cause of diarrhea in children less than 5
• 6-12 month old and immunocompromised children are THE MOST VULNERABLE
• Spread through fecal-oral transmission or person to person (through day-care)

Symptoms
- Fever and vomiting for 2 days then diarrhea for 5-7 days.

Treatment
- Look for symptoms of dehydration (rehydrate if severe)

Question 5

Escherichia-Coli (E-Coli)

Answer 5

• Food born pathogen
• Watery diarrhea for 1-2 days then severe abdominal pain and bloody diarrhea

MAY PROGRESS TO HEMOLYTIC UREMIC SYNDROME

Diagnosis
- Sorbitol MacConkey Agar (SMAC) - Tests stool for blood

Treatment
- ANTIBIOTICS CAN MAKE INFECTION WORSE
- AVOID ANTI-MOTILITY AGENTS (IMODIUM AD) AND OPIOIDS

Question 6

Clostridium Difficile (C-Diff)

Answer 6

• Extremely watery diarrhea
• May cause pseudomembranous colitis, leukocytosis, hypoalbuminemia

Treatment (Antibiotics)
- Metronidazole
- Vancomycin

• C-diff can live on hard surfaces up to 3 days.
• Strict soap and hot water hygiene (hand sanitizer does not kill it)

Question 7

Evaluation/Treatment

Answer 7

• Get an accurate history on medications, travel, new pets, day care, exposure to untreated water, diet changes

Symptoms
- Urinary output (dehydration)
- Character of stool
- Frequency of stool

Treatment
- IV fluid replacement for severe dehydration
- Oral rehydration therapy for mild dehydration

Rehydration maintenance
- 10 mL/kg of oral rehydration PER DIARRHEAL STOOL
- Pedialyte is very commonly used for rehydration in younger kids
- Older kids may be given Gatorade

Question 8

Education

Answer 8

• Avoid caffeine (diuretic)
• Avoid fruit juice, carbonated drinks, gelatin because they do NOT help with diarrhea. they have high carbohydrates, low electrolytes, and high osmolarity.
• Look out for signs of dehydration such as I&O

BRAT DIET - IS NOT RECOMMENDED
- Has little nutrition, high carbohydrates and low in electrolytes.

• Now it is recommended to resume normal well-balanced diet in about 24 hours after being sick (if possible).