Diarrhea and dehydration

Question 1

List the classic mechanistic classification scheme for diarrhea.

Answer 1

Osmotic: water moves into gut in response to presence of poorly absorbed solutes

Secretory: enterotoxin induced cAMP in endothelial cells and increased chloride secretions
no reduction in stool volume with fasting
salmonella, e.coli, shigella, c, diff

Altered motility

Dysentry: compromise of bowel wall causing bloody mucous diarrhea
shigella, salmonella campylobacter

Question 2

List 4 viral causes of diarrhea.

Answer 2

• Rotavirus (MC cause worldwide diarrhea

Question 3

List the most common bacterial causes of diarrhea in North America.

Answer 3

• Shigella
• Campylobacter
• Salmonella
• Yersinia enterococcus
• E-Coli (ETEC, EHEC, EIEC)
• Less common (

Question 4

List the 3 most common causes of parasitic diarrhea in NA:

Answer 4

• Cryptosporidium
• Giardia
• Entamoeba histolytica

Question 5

what diarrhea needs antibiotic treatment

Answer 5

treatment indicated for very young, immunocomprimised, medically complex, dysentery, or very long course. Only one in healthy people that needs treating is campylobacter, ETEC and salmonella typhi

Question 6

List indications for hospitalization for diarrhea.

Answer 6

• Very young
• Premature
• Protracted vomiting
• Diarrhea in excess of fluid administration
• Worsening condition despite therapy
• Underlying condition that would complicate therapy
• Systemic involvement

Question 7

What is the Gorelick score?

Answer 7

Dehydration score
1 point each for:
- Capillary refill > 2sec
- Absent tears
- Dry mucous membranes
- Ill general appearance

Mild (10%): Gorelick 3-4
Shock: Abnormal VS

Question 8

Summarize how to estimate and administer ORT:

Answer 8

1. Estimate degree of volume depletion (mild or moderate)
   
   2. Calculate desired volume
      
      • Mild: 30-60mL/kg
      • Mod: 60-80mL/kg
   3. Administer 25%/hour over 4 hours
   4. Re-evaluate at 4 hours