Acute Diarrhea

Question 1

Causes

Answer 1

Acute infectious • Acute gastroenteritis (viral ”rotavirus, adenovirus, enteroviruses”, bacterial “salmonella,
shigella, C. dificile, c a m py l o b a c t e r, Ye r s i n i a , c h o l e r a , E . C o l i ” ) • Extra intestinal infections (otitis media, UTI, pneumonia, typhoid fever, sepsis)
Acute non-infectious • Dietic (overfeeding, starvation, bad diet) • Drugs (laxative, antibiotics) • Acute abdomen (intussusception, acute appendicitis, peritonitis) • Part of systemic disease (usually present with chronic diarrhea).

Question 2

Hx

Answer 2

Are the lose motion interspersed by normal ones?

Associated symptoms:
• Fever
• Vo m i t i n g
• Pain
• Distention
• Jaundice
• Urinary symptoms
- ear tugging
• Concurrent problem:
• Joint pain and
swelling • skin rash • dysphagia • oral ulcer • perianal fistula

• previous similar attack? • Contact with sick patient? • Antibiotic use? • Tr a v e l l i n g ? • Oral intake? Weight loss? Activity? • Urine output?

• Past surgical:
• bowel resection
• congenital GIT anomalies repaired • Medications:
• laxative or antibiotics • Allergy: cow milk

Family history
• Consanguinity
• Similar case in the family
• Immunodeficiency
• Celiac disease
• IBD

Question 3

INVESTIGATIONS

Answer 3

Based on the Data from history and physical
examination
• Stool analysis and culture
• Stool electrolytes
• CBC and inflammatory markers
• Renal function and serum electrolytes
• Urine analysis and culture
• Other special tests according to the cause

Question 4

TREATMENT

Answer 4

• First, stabilize the patient (ABCs) msinly c = fluid
• Hydration • Electrolytes replacement • Proper diet • Anti-diarrheal meds?
• Antibiotics? Less than 3 m / immuncompramosed / bac infection / shock / sepsis
• Special treatment for systemic disease

Question 5

DEHYDRATION

Answer 5

Vo l u m e d e p l e t i o n o r d e hy d r a t i o n o c c u r s w h e n f l u i d i s
lost from the extracellular space at a rate that
exceeds intake.

Question 6

Why Infants with diarrhea are at increased risk for dehydration
?

Answer 6

Higher body surface area-to-volume ratio when

compared to older children or adults • There is a higher frequency of gastroenteritis • Dependent on others for fluid

Question 7

THE MOST COMMON SITES FOR EXTRACELLULAR FLUID LOSS ARE:

Answer 7

• Gastrointestinal tract (eg, d i a r r h e a , v o m i t i n g ) • Skin (eg, f e v e r, b u r n s ) • Urine (eg, glucosuria, d i u r e t i c t h e r a py, d i a b e t e s insipidus)

Question 8

TYPES OF DEHYDRATION

Answer 8

• Isonatremic dehydration • Hyponatremic dehydration • Hypernatremia dehydration

Question 9

LABORATORY TESTING

Of dehydration

Answer 9

Electrolytes and acid-base

• Na •K • HCO3 • BUN

Question 10

HYPONATREMIA

Answer 10

Symptomatic hyponatremia manifests most commonly with
neurologic dysfunction.
• Nausea and malaise. Headache, lethargy, obtundation, a n d
seizures may occur as the serum sodium continues to fall
below 120 mEq/L
The primary problem with symptomatic hyponatremia is
evolving cerebral edema, a n d t h e r i s k o f m o r b i d i t y f r o m
delayed therapy is greater than the risk of complication from
too rapid correction and osmotic demyelination.

Question 11

HYPERNATREMIA

Answer 11

Results from the loss of free water due to increased insensible
losses because of fever or sweating, urinary concentrating defects as
in diabetes insipidus, o r r e l a t i v e l y d i l u t e d i a r r h e a l f l u i d .
• Children with a serum sodium concentration above 155 mEq/L who
are corrected too rapidly are at greatest risk of such neurologic
sequelae, particularly seizures (cerebral edema).

Question 12

FLUID BOLUSES

Answer 12

• Intravenous:
20 ml/kg over 5 min
10 ml/kg over 10-30 min in cardiac and renal
disease.
• ORS:
Repletion phase: 50-100 ml/kg over 4 hours.

Question 13

HOW TO CALCULATE FLUID DEFICIT

Answer 13

Fluid deficit
• Percentage of dehydration X weight (Kg) X 10
• “half in first 8 hours and the other half in the remaining
16 hours”
Note: you should subtract the boluses from the total deficit volume.

Question 14

HOW TO CALCULATE FLUID MAINTENANCE

Answer 14

Maintenance IV fluid over 24 hours
For the first 10 Kg                 X 100
For the second 10 kg          X 50
For each Kg above 20       X 20
• Maintenance ORS
5-10 ml/kg/diarrheal stool
2 ml/kg/emesis

Question 15

COMPLICATIONS of dehydration

Answer 15

• Shock • Acute renal failure • Electrolyte disturbance • Acid base disturbance • Convulsion • DIC • Heamoconcentration