You are on page 1of 9

See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/291529668

Acute diarrhea in children

Article  in  Srpski arhiv za celokupno lekarstvo · January 2015
DOI: 10.2298/SARH1512755R

CITATIONS READS

2 3,573

5 authors, including:

Nedeljko Petar Radlovic Zoran Lekovic
University of Belgrade University Children's Hospital, Belgrade, Serbia
76 PUBLICATIONS   294 CITATIONS    33 PUBLICATIONS   88 CITATIONS   

SEE PROFILE SEE PROFILE

Biljana Vuletić Vladimir Radlović
Pediatric clinic Clinical Centre of Kragujevac University Children's Hospital, Belgrade, Serbia
60 PUBLICATIONS   74 CITATIONS    43 PUBLICATIONS   107 CITATIONS   

SEE PROFILE SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Albumin indications and contraindications i pediatric patient and Treatment of hematological emergencies in surgical patients View project

Troponin I as prognostic marker of perinatal asphyhia View project

All content following this page was uploaded by Zoran Lekovic on 30 January 2016.

The user has requested enhancement of the downloaded file.

North America and Australia. adenovirus.34-008. 3]. The Acute diarrhea is the most frequent gastroin.2 755 Acute Diarrhea in Children Nedeljko Radlović1. 2. 8. Vladimir Radlović3. Serbia. African and South Asian countries.700). while bacterial causes Sepsis and meningitis 5.e. except antipyretics in high febrility. in addition ity in children until completed fifth year of life to the classical manner. the developing countries. are viruses Prematurity 14. Nigeria (151. Keywords: acute diarrhea. 11000 Belgrade Malaria 7. 3]. norovirus and Shigella [10. Salmo- Other 11.314. watery or loose stools daily [1-5].6 nella. are much rarer [1. 10]. the leading cause of mortal. Viral causes of acute diarrhea.2 of the disease (Campylobacter jejuni. antidiarrhetics and spasmolytics is unnecessary and potentially risky. This primarily regards uncritical use of antibiotics and intestinal antiseptics in the therapy of bacterial diarrhea. Dušica Simić2.143(11-12):755-762 DOI: 10.000). can be spread through (Table 1) [1. viral and bacterial.3 lamblia. and in recurrent cases and gen. one-and-a-half million children it also depends on the stage of development of the child’s surroundings [3. According to the data aerogenic transmissions [10]. morbilli and other 28. and particularly in the second half-year and in The most frequent cause of acute diarrhea are small children [1. and the main cause of dehydration in childhood. so that it is not recommended for children with AD. the highest incidence is recorded in and rarely parasitic (Tables 2 and 3) [1-5. School of Medicine. calicivirus. 4 University of Kragujevac. ghanistan (82. Biljana Vuletić4. Correspondence to: Pneumonia 14. and more rarely alimentary intoxications and other factors. therapy INTRODUCTION in the world die of acute diarrhea. viral and bacterial. of children who died of acute diarrhea are from dration in childhood [1. 7]. Belgrade. It is manifested by a sudden occurrence of three or more watery or loose stools per day lasting for seven to 10 days. 3. n. contaminated food and water diarrhea is globally primarily due to dehydra. worldwide. Faculty of Medical Sciences. Other therapeutic measures. As dehydration and negative nutritive balance are the main complications of AD. Serbia. It is character. Serbia SUMMARY Acute diarrhea (AD) is the most frequent gastroenterological disorder. AIDS. ness show rotavirus. diagnostics. Belgrade. Prevalence of of the World Health Organization (WHO) specific intestinal pathogens is age-related but from 2004. Serbia. i. 8].4 years of age. hypovolemia.net . The infections are spread by fecal–oral pathological conditions and pneumonia. Etiological factors of mortality of children under quent etiological factors of acute infective diar- the age of five in the world [7] rhea in Europe. eral malnutrition.2.2298/SARH1512755R ПРЕГЛЕД ЛИТЕРАТУРЕ / REVIEW ARTICLE UDC: 616.3. In addition. 2. electrolyte disbalance individual [9. 2. mainly in countries with low standard of living [7]. ETIOPATHOGENESIS dren during the first five years after birth. norovirus.Srp Arh Celok Lek. where most ized by a sudden occurrence of three or more were from India (380. Giardia Serbia Injuries.radlovic@beotel.3 range from six months to five years. which primarily affect children in Nedeljko RADLOVIĆ Diarrhea 9. Acute diarrhea primarily occurs in chil. 14 days at most. Its primary causes are gastrointestinal infections. Zoran Leković3.700).3 1 Academy of Medical Sciences of the Serbian Medical Society.e. Particularly high contagious- and acidosis. 9]. abdominal pain and elevated body temperature [1. The use of antiemetics. Factors % the developed countries. Af- the initial phase of the disease is often accom. 3. Kragujevac. meningitis. etiopathogenesis. 11]. anti-amebiasis and probiotics are rarely necessary. 2. same WHO document reports that over 80% testinal disorder and the main cause of dehy. antiparasitic drugs for intestinal lambliasis. Entamoeba histolytica and Cryptospo. Except for neonatal 9.600). Democratic Republic of Congo (899. it is clear that the compensation of lost body fluids and adequate diet form the basis of the child’s treatment. The most fre- Table 1. Shigella and pathogenic species of Esch. 10]. 2 University of Belgrade. 3]. 3 University Children’s Hospital.100) and Ethiopia (73. 2.9 the first six months after birth and after five University Children’s Hospital Tiršova 10. particularly at the age Total 40. panied by anorexia.4-053. 6.1 (rotavirus. Belgrade. vomiting. Although it is present gastrointestinal infections. or direct or indirect contact with an infected tion.1 erichia coli). Neonatal factors Intrapartal complications 9. 2015 Nov-Dec.4 astrovirus and others). It mainly occurs in children until five years of age and particularly in neonates in the second half-year and children until the age of three years. acute transmission. i.

15]. such as sepsis. In these environments parasitic Campylobacter diarrheas were significantly more frequent as well [3]. Escherichia coli Bacteria (10-20%) [8] (enteropathogenic and enterotoxigenic). Staphylococcus aureus excretes a thermostabile. acute diar- Campylobacter rheal disorders are caused by alimentary intoxications. as the consequence of the disintegration of colonic bacte- ria (Salmonella. In children in developing countries. laxa- Rotavirus tives. es. chemotherapeutics Alimentary intoxications are characterized by a secre. Adenovirus pecially in tropical and subtropical regions. Erythromycin. 14. Dientamoeba fragilis. Blastocystis hominis Helminths Strongyloides stercoralis ridium are even more rare causes of acute diarrhea [1. depending on the type. Giardia thus it is not rare that their application is followed by feel- lamblia and Cryptosporidium adhere to mucosal surface ings of nausea. owing to un. The most severe disorder of this type is histolytica [3. norovirus (norwalk-like virus). the situation is also similar in Norovirus <1 our surroundings. as a component of antibiotic therapy occurs ruses. infectious diar- rheal disorders are classified into three basic groups. 19]. which Contrary to infections. i. Categorization of most frequent causes of acute diarrhea in 3. abdominal pain and diarrhea [20]. 8]. blood-stained stools [3]. 17]. and toxigenic strains of E. Viruses (rotavirus and other) Small bowel 15]. although there as well as in Adenovirus developed countries rotavirus ranks as the leading single 1–4 Salmonella* cause of the disease [3]. Norovirus typhoid and paratyphoid fever. 13]. secretory. according to children’s age [5] economically developed group of countries. mechanisms – oral iron preparations by irritative (pro- rheal disorder [3]. bacterial diar. coli. Table 3. 13]. purgatives by laxative. Cryptosporidium. including cholera. Clostridium difficile. Acute Diarrhea in Children Table 2. Accordingly. while Clostridium perfringens and Bacillus cereus excrete 9. Clostridium difficile enterocolitis [12. et al. 15]. as well as Rotavirus to people’s education level. >5 Salmonella* wide-spectrum antibiotics. Enteropathogenic E. osmotic and osmotic. Year Virus enviable level of children’s healthcare insurance. of the proximal small bowel. particularly those with chronic inflam. exert their Shigella Colon pathogenic effect in both bowel segments. irritable bowel syndrome [22]. stress- * non-typhoidal species related conditions and severe extraintestinal infections in infancy period. Yersinia enterocolitica. Causes of acute infective diarrhea [8. except for antibiotic ef- exudative-secretory by aqueous-mucilaginous and often fect. coli. Diarrhea. Campylobacter matory intestinal diseases and malignancies. contaminated by enterotoxins of Staphylococcus aureus. thus. Yersinia In addition to gastrointestinal infections. cytostatics. oxidative) effect. Salmonella* Rotavirus rheas were significantly more frequent. primarily causing a malabsorptive form of diar. enterovirus Campylobacter jejuni. Shigella. Entamoeba histolytica. gastric secretion suppressors (proton pump tory diarrheal disorder caused by the ingestion of food inhibitors and H2 blockers) by prokinetics. Vibrio cholerae Protozoa (<10%) [8] Giardia lamblia. 9. vomiting. urinary tract infection. Salmonella (animal/non-typhoidal species). Stress conditions disturb vegetative body function. also act stimulatively on the gastrointestinal motility. gastric secretion suppressors. Secretory diarrhea is caused by Vibrio cholerae a thermolabile enterotoxin. 2. Although this country is not considered part of the Europe.e. in- Clostridium perfringens and Bacillus cereus [3. Shigella.2298/SARH1512755R . astrovirus. by compromising its Other medications cause a diarrheal disorder by various function. pneumonia and other [1]. Entamoeba histolytica From the pathogenetic point of view. cluding the gastrointestinal motility and secretion. there is no bacterial colonization constitute the bases for diarrheal episodes in persons with of bowls. by cytotoxic. secretory diarrhea is characterized by liquid stools. 14] media. 12. Localization of the causes of gastrointestinal infections [9. 16. 8. adenovirus (serotypes 40 and 41). etc [21]. osmotic-secretory by vi. Vibrio cholerae Infectious causes of acute diarrheal disorder colonize Enterotoxigenic Escherichia coli the small bowel and/or the large bowel (Table 4) [3. Viral infection affects only the small bowel causing Giardia lamblia invasion and destruction of the mature epithelium. doi: 10. 10] Viruses (~70%) [8] Rotavirus. and exudative-secretory by enteroinvasive bacte. Salmonella typhi and paratyphi. Yersinia pseudotuberculosis. can cause Distal ileum and colon Enteroinvasive Escherichia coli most severe Clostridium difficile (pseudomembranous) Yersinia enterocolitica enterocolitis [9. It is necessary to point Cause Localization out that a prolonged usage of wide-spectrum antibiotics Salmonella even in children.756 Radlović N. while Cryptosporidium bacteria and parasites. oral iron preparations. otitis Table 4. osmotic-secretory and exudative-secretory [1. and azithromycin and other macrolides. Campylobacter) and Entamoeba rial flora [18.

However. www. 2015 Nov-Dec. particularly six to nine months after birth. 3. In most cases the tonic or hypertonic (Table 6) [8. poorly nourished or treated with an overly restrictive Isonatremic (Na+ 130–150 mmol/L) diet.or hyperkalemia and hypoglycemia. as a component of extraintes. amebic liver abscesses and Na+ (mmol/kg) 8 others [2. vomiting. Owing to compensatory prenatally. but also as a Contrary to infections.rs . in infants aged six to nine months. Mild (<5%) Second most frequent complication that occurs due to Degree of body weight loss [27] Moderate (5–10%) anorexia. initial phase of the disease is followed by increased fever Electrolyte deficit is equivalent to the degree of dehy- (one to three days). 28. while Rotavirus 3 (1–3) hyponatremic dehydration occurs in infants who are pri- Norovirus 1 (1–2) Astrovirus 1–2 marily inadequately rehydrated. with osmotic Cause Incubation period (days) diarrhea and on a diet of non-adapted cow’s milk. i. more severe dehy- Shigella 3 (1–7) dration is followed by decompensated metabolic acidosis. vomiting and fever [1. 9]. gastrointestinal infections in gen. 24]. or with mild clinical symptoms [3. and colitis by mucous defined by the level of sodium in serum. undernourished and with prolonged Campylobacter 3 (1–7) diarrheal disorder [30]. sudden onset manifested dration developing due to diarrhea. and the most Cryptosporidium 7 (1–14) severe sensorial disorder. 12 Rare complications of acute infections also involve 3 immune-mediated extra-intestinal manifestations. convulsions and anuria [2. etc. paralytic ileus. of sodium [27.) that primar- 5 ily develop in younger infants and immunocompromised Loss of body weight (%) 10 children with Salmonella enterocolitis. Besides watery diarrhea. i. Water and electrolyte deficit in isotonic diarrheal dehydration complications of the disease are bacteremia and conse- [27. Enteritis is char.srp-arh. in most children diarrheal dehydration is those who are breastfed. 17]. Parameter Deficit endocarditis. Owing to the natural passive immunity acquired hypernatremic dehydration. particularly in children of the youngest Hypertonic (>295 mOsm/kg) age. rectal mucosal prolapse. 28] quential metastatic infections (osteomyelitis. 30]. the loss of BW can progress to severe overall mal- Blood level Hyponatremic (Na+ <130 mmol/L) nutrition [2. intestinal 150 invagination and perforation. severe. and much rarer hypernatremic (5– 15%) or hyponatremic (5–10%) [28. As a consequence of severe hypovolemia.3–1) dium substitution.Srp Arh Celok Lek. 3. According to severity. isotonic. while according to osmolality. 27. meningitis. which is primarily acterized by watery and postprandial. tubular necrosis is also According to Classification possible [31]. In children during the first years of life. pain. 19. Rarer Table 7. 9]. It is the highest in hyponatremic. 2. 3]. moderate or within 14 days (Table 5) [1. and in case of colitis a false need to pass stools. it can be mild. eral. toxic mega- 4 colon. 26]. Hypernatremic Table 5. In addition. is highly complex and insufficiently clear. Basic clinical characteristics of acute infective diarrhea are Basic complication of acute diarrheal disorder is dehy- relatively short incubation period. 30]. prolonged Table 6. vomiting and abdominal colic. numerous factors that disturb the characterized by a very short latent period (usually 10–12 gastrointestinal integrity [23]. liver and spleen abscesses. Giardia lamblia 9 (7–14) hypo. 25]. who are febrile. vomiting. the disease is almost regularly followed CLINICAL FEATURES by an intensive feeling of nausea. Incubation period in acute infective diarrheas [10] dehydration occurs most often in infants. It occurs as a consequence of antibiotics use. isonatremic (85%).e. as well as the absence of febrility [16. loss of appetite. mostly present in Water (ml/kg) 100 the first and rarely in the second year of life.143(11-12):755-762 757 Pathogenesis of diarrhea. by frequent watery or loose stools and a complete recovery 2. particularly in mechanisms. alimentary intoxications are consequence of other. which K+ (mmol/kg) 6 usually occur after the cessation of diarrhea (Table 8) [3. without sufficient so- Salmonella (non-typhoidal) 1 (0. hypo- or mucous-hemorrhagic stools [3. sometimes 30 minutes) and clinical course (mostly one day). as well as chronic 15 post-infective diarrhea induced by overly restrictive diet 50 and/or unnecessary antibiotic therapy. 24. and in particular viral ones. diarrhea and fever is negative nutri- Severe (>10%) tional status followed by reversible loss of body weight Isotonic (275–295 mOsm/kg) (BW) [1]. in cases with frequent and prolonged Osmolality [29] Hypotonic (<275 mOsm/kg) diarrheal episodes. 29] Hyperosmolar (Na+ >150 mmol/L) febrile (benign) convulsions are also common [32].e. abdominal dration (Table 7) [28]. hours. and followed by that in isonatremic. 3]. are usually asymptomatic tinal infections. Classification of dehydration hypoperfusion and renal hypoxia. 29]. and it is the lowest in tenesmus. 9 4.

9]. Yersinia. Entamoeba histolytica and cordingly further treatment is to be continued [30]. plete clinical examination and adequate laboratory analyses while in conditions of severe dehydration rehydration is [1-5. Imune-mediated complications of acute infective diarrhea [9] 2. into account. Within physical exami- nation. the tein. the remaining 50% during the next 16–24 hours. Salmonella this pathologic condition [5]. Yersinia diarrheal disorder. 38].9% NaCl or Ringer’s lac- values of Na. either intes. 38]. isonatremic and hyponatremic dehydration 50% of fluid tion of the abdomen. in doses of 20 ml/kg BW of represents a frequent manifestation of viral diarrheas. the verification esis. It is also important to acquire knowledge about the presence of identical problems in the child’s surroundings (family. stan. 34]. but if a child Hemolytic anemia Campylobacter. During this procedure. Campylobacter. If the patient’s condition does not improve. are obtained by parents or a custodian. as well as the con. hours [27]. To restore volemia. Salmonella. leukocytosis. fever. which rapid infusion is applied. acute tubulonecrosis should be kept in mind. does not require Salmonella. orally. Campylobacter. Probiotics and symbiotics can be useful. it is necessary tinal or extraintestinal. by the use of oral rehydration solutions (ORSs). not faster than lost water and electrolytes and adequate nutrition [1.9% NaCl during 10–20 minutes. Similarly. can cause myelinolysis (demyelination) at the level of the doi: 10. glucose. which is almost always the stool currently present the method of choice in the diagno. Confirming viral particles in stool by the use in addition to the insight into the patient’s condition. Intravenous rehydration sumption of unsafe food or water. thus the treatment basis consists of replacement of ization of serum sodium must be slow. 3. The treatment of acute Shigella. 3. bolus or more as well. the child itself if of older age. 27. ponatremic dehydration requires a period of 24–36 hours. Yersinia is older than three months (BW>5 kg). With the In children acute diarrhea mostly withdraws spontane. coli O157:H7. In cases of restored volemia and absent dier- adenovirus gastroenteritis [33]. aim of preventing a relative hypernatremia. because a rapid correction of hyponatremia plication of antibiotics is justified only in certain cases [1. 2.6 × (135 – actual serum Na+ in mmol/L). Reactive arthritis Campylobacter. erythrocyte sedimentation rate). Laboratory analyses involve serum to use intravenous infusion of 0. acid-base status. then ibuprofen is IgA nephropathy Campylobacter the medicine of choice as well [36]. Therapy with acceptance and tolerance of food. i. 0. tate in the dosage of 10–30 ml/kg BW during one to three biochemical parameters of inflammation (C-reactive pro.2298/SARH1512755R . and ac- of antigens of Giardia lamblia. creatinine. case.5 mmol/L per hour [27. There is evidence that Smecta (diosmectite) and Complications Causes racecadotril represent useful adjuvants in the therapy of Erythema nodosum Yersinia. and the type of complications. except if there is an Hemolytic-uremic syndrome E. Shigella. in order to restore circulating volume. Yersinia tion or some other serious complication. Patients suspected of lactose intolerance. Campylobacter. hospitalization [37]. the normal- ously. abdominal pain and other rection but also coverage of the present pathologic and complaints. special attention In the initial phase of rehydration of the patient with se- should be paid to the degree of dehydration. In perforation require radiological and ultrasound examina. which must always be all-inclusive. 4. i. Cl. 13. highly reliable and also necessary to keep assessing central venous pressure most frequent procedure in the diagnosis of rotavirus and and dieresis. while the ap. Sodium deficit in hypotonic dehydration is THERAPY calculated by the following formula: Na+ (mmol) = BW (kg) × 0. a full correction of fluid deficit in isonatremic and hy- sis of parasitic and pseudomembranous enterocolitis [12. Patients with suspected intestinal invagination or and in hypernatremic dehydration 36–48 hours [27.e. Antipyretic Yersinia of choice for children’s age is paracetamol. collective). This must be strictly taken 5]. et al.758 Radlović N. it is of the agglutination test is a practical. stool [3. except in the case of severe dehydra- Glomerulonephritis Shigella.e. or other examinations depending on restoration is achieved during the first eight hours. If the Cryptosporidium and Clostridium difficile toxins A and B in patient’s condition is stabilized. i. 9]. as well as the water and electrolytes does not involve only deficit cor- presence of vomiting. it is 0. K. as well as other complications. Cryptosporidium Rehydration of children with acute diarrhea DIAGNOSTICS Mild and moderate dehydration caused by acute diarrheal disorder are in about 95% of cases successfully corrected Diagnosis of acute diarrhea is based on anamnesis. 30]. the state of vere dehydration followed by shock or preschock condi- consciousness. Acute Diarrhea in Children Table 8. 5]. which can be repeated useful to determine the presence of reductive substances in up to twice within one hour [39]. and in certain cases hemoculture next one to three hours. Reiter syndrome Campylobacter. com. Antipyretics are not indicat- Guillain–Barré syndrome Campylobacter ed for children with fever below 39°C.e. additional reason for their administration [35]. Data on the frequency and appearance of stools. same treatment is repeated again once or twice during the dard urine examination. or by physiologic losses [27]. while in hypernatremic dehydration this procedure must be more gradual [27]. diuresis. tion. performed by intravenous route [3.

5 mmol/L per hour [27. In solution and similar means have no physiological basis and most cases it is sufficient to compensate one third to one therefore cannot produce adequate results [40]. 38]. 41]. According to current recom- mendations. whose diet is in no case interrupted [3. 60 50–80 60 sation of seizures [38]. Therapy is applied un. physiological mula: NaHCO3 (mmol/L) = BW (kg) × 0. 40]. 3. It can be also given tive. 43] by permanent sequelae. 9]. 38]. it has no other der both hospital and home conditions. i. Stepanović. the speed rate of serum sodium decrease in hypernatremic dehydra- tion also must not be higher than 10–12 mmol/L per 24 pathogenesis of diarrheal disorder and it fully corresponds hours or 0. This also refers to breastfed infants. The concentration of potassium in infusion fluid should not be higher than 40 mmol/L and is admin. 3. [3]. about 50% of patients achieve it can contribute to the development of hemolytic-uremic rehydration after 24 hours [40]. after the appearance of diarrhea and/or vomiting and is continued until a complete normalization of digestive functions [2. i. 5% or 10% glucose. in some cases it is counterproduc- ing a small spoon. in regard to sodium-glucose cotransport [40-43]. sweetened tea. 1992 well as cerebral hemorrhage and thrombosis. sour milk. 44]. sodium level every two to four hours [27. After three to four hours of rehydration. 37. coli strain infection abovementioned principles. while pathological condition which. artificially-fed children. given lactose-free milk formula. **By prescription of N.rs . 9]. followed Table 9. if routinely applied in Salmonella enteroco- through the nasogastric tube [37].e. generally viewed. To prevent dehydration. It is www.srp-arh. Precondition for the compensation of potassium is pa- tient’s recovery from the state of shock. 2. cheese) potassium and bicarbonate or citrate. 5. malignancy and able on the market under the brand name Orosal 65. particularly the pons. In milder of 3–4 mmol/L per 24 hours. 43. withdraws spontaneously dose is 100 ml/kg BW and for mild 50 ml/kg BW over a within one to two weeks. com. The only exception are children with transient lactose intoler- Rehydration by natural (oral) route is based on the active ance associated with viral diarrhea who are. 37].143(11-12):755-762 759 central nervous system. restored diure. the menu of a child should be identical to Oral rehydration that before the onset of the disease [1. except in favoring germ spreading. is most often unnec- An ORS is administered in frequent and small sips us. fruit administered intravenously according to the following for.Srp Arh Celok Lek. Gastroenterology. Orosal 65** Parameter WHO. (mmol/l) Cl. 37]. Thus. In about 5% of cases oral syndrome [5. its intravenous application in the Glucose (g/1) 13–20 ≤20 20 dosage of 4–6 ml/kg usually results in the withdrawal of Osmolality (mOsm/kg) 225–260 225–331 281 symptoms [38]. ESPGHAN. Antimicrobial therapy tially or after oral or itravenous rehydration. because. diet is not interrupted the correction of dehydration and metabolic acidosis. 3. Radlović and R. begins immediately if the child is older than one year [8.e. The chronic inflammatory bowel disease and moderately se- composition of the preparation is adopted to this region vere forms of Clostridium difficile enterocolitis [5]. and patients with immunodeficiency. 3. 2015 Nov-Dec. i. an ORS is administered at a rate of 10 ml/kg BW after each watery As mentioned above. either oral or in- istered via a continuous intravenous infusion in the dose travenous. litis. essary [5. 45]. Hepatology and Nutrition (ESPGHAN) ponatremia and hypernatremia requires control of serum and WHO (Table 9) [5. Moreover. while in enterohemorrhagic E. antibiotic therapy for acute course of three to four hours [2. only salmonellosis in younger infants (< 3 months old] ORSs produced by Galenika in this country is avail. Finally.25 or HCO3 below 10 mmol/L requires bicarbonate rheal disorder with drinking water.e.e. the patient is offered food [1. half of the calculated dose. i. of water and electrolyte loss in patients with acute diar- low 7. glucose. 38]. 10* 25–35 25 sodium for 1 mmol/L. juices and other drinks. So as to prevent to the guidelines of the European Society for Pediatric the abovementioned complications. Absolute indication for antibiotic therapy fluid resuscitation remains unsuccessful and replaced with of bacterial diarrheal disorders that occur in Europe are the intravenous one. posed of a determined combination of sodium. bottle or cup [2]. the correction of hy. bacterial diarrheas. either ini. until Electrolytes K 20 15–20 20 + the clearly visible improvement of consciousness and ces. without manifest dehydration diarrhea also present hyperkalemia that is normalized after and with an adequate ORS intake. Intake of ORSs. As 1 ml/kg of 3% NaCl increases HCO-/citrate3. More severe forms of acute forms of the disease. 1994 1992 Galenika tered at a speed rate of 1 ml/min until the rise of sodium Na+ 60 60–90 65 concentration in the serum up to 120 mmol/L. fermented milk products (yoghurt. Because of the danger of brain edema as * Citrate (1 mmol=3 mEq). 5]. bolus NaCl 3% is adminis. 2. it should be pointed out that the compensation Decompensated metabolic acidosis with blood pH be. In symptomatic hyponatremia. with compensation of lost to correct moderately severe dehydration the administered fluids and adequate nutrition.3 × –BE [32]. acute diarrheal disorder represents a stool or 2 ml/kg BW after each episode of vomiting. Nutrition sis [27. By adhering to the effects. ESPGHAN and World Health Organization (WHO) recommen- dations for composition of ORS and Orosal 65 [42. and even lethal outcome [27].

editors. et al. In other bacterial diarrheas to their higher stability and resistance to acid peptic and the application of antibiotics can only contribute to some biliary pancreatic activity.. 2013. Lawn JE. Kahn SA. meningitis of four weeks and osteomyelitis of four to six weeks [46]. et al. and in regard to infections. Acute gastroenteritis in children. Dite P. Salam MA. due severe forms of shigellosis [5].0b013e31816f7b16] [PMID: 18460974] [DOI: 10. Sanderson Diseases. 5] Cause Antibiotic Daily dose of drug and mode of application Duration of treatment (days) Ampicillin 50–100 mg/kg per os or IV in 4 doses 5–7 Salmonella Ceftriaxone 50–100 mg/kg IV or im in 1 dose 5–7 Ciprofloxacin 20–30 mg/kg per os in 2 doses 7–10 Ampicillin 50–100 mg/kg per os or IV in 4 doses 5–7 Shigella Ceftriaxone 50–100 mg/kg IV or im in 1 dose 5–7 Ciprofloxacin 20–30 mg/kg per os in 2 doses 7–10 Erythromycin 50 mg/kg per os in 3–4 doses 5 Campylobacter jejuni Azithromycin 5–10 mg/kg per os in 1 dose 5 TMP/SMX 10/50 mg/kg per os in 2 doses 7–10 Yersinia enterocolitica Gentamicin 3–5 mg/kg im or IV in 1–3 doses 7 Ampicillin 100 mg/kg per os or IV in 4 doses 5 EPEC. In: Kliegman RM. [DOI: 10. Osterrieder S. European Society for Paediatric Gastroenterology. 37]. 334(7583):35- R. Hepatology. Liu L. Lancet.1323-39. 2009. IV – intravenous understood that it’s indicated in patients with threatening and other antidiarrheal drugs. 5]. Salazar-Lindo Health Epidemiology Reference Group of WHO and UNICEF. Shamir 8. Acute diarrhea in adults and children: a global regional. [PMID: 22579125] Schol NF. 46]. editors. 50. systematic analysis for 2010 with time trends since 2000.1136/bmj. Bhutta ZA. as well as in cases dansetron and similar) are not recommended for children of metastatic infections [9. Lindberg G. 4]. component in the prevention of the development and alle- ics (symbiotics) essentially contribute to the alleviation viation of infective diarrhea. UNICEF/WHO. and Nutrition/European Society for Paediatric Walker’s Pediatric Gastrointestinal Disease.0b013e31826df662] [PMID: 23222211] 2012. Microencapsulated probiotics and prebiotics.406169. 379(9832):2151-61. Guandalini S. [DOI: 10.760 Radlović N. while racecadotril probiotics and symbiotics have a significant role in the pre- and diosmectite decrease fecal water and electrolyte loss. related to food and water represents the basis in the pre- vention of alimentary infections and intoxications.39036. EIEC – enteroinvasive E. WHO. 51]. Gastroenteritis in children. Geneva/New York: UNICEF. Nutrition/European Society for Paediatric Infectious doi: 10. 5. Dtsch Arztebl Int. 18. 5. Khalif I. 47].253-64. Mieli-Vergani G. 37. [DOI: 10. coli. 5th ed. particularly viral [1-4]. Acute diarrhea. Philadelphia: Elsevier. Cousens S. 47(1):12-20. Pediatr Gastroenterol Nutr. J Clin Gastroenterol. BMJ.2009. WGO. cause [5]. et al.3238/arztebl. be done. There is no doubt that breastfeeding is the essential 47. J 2. ETEC – enterotoxigenic E. IR. Nelson Textbook of 7. Global. 2011. coli.80] [PMID: 17204802] Hepatology. et al. Behrman RE. Antimicrobial drug of choice for fighting Strict adherence to basic hygienic and sanitary measures intestinal lambliasis and amebiasis is metronidazole [4]. coli. TMP/SMX – trimethoprim-sulfamethoxazole. Sherman PM. and national causes of child mortality: an updated perspective. Guarino A.1016/S0140-6736(12)60560-1] 4. 48]. p. Shneider B. St Geme III JW.1097/MCG. Hamilton: BC Infectious Diseases evidence-based guidelines for the Decker Inc. Scott S. Acute infectious diarrhea in children. Salmonella bacteremia requires antibiotic therapy of two PREVENTION weeks. 2007. Koletzko S. Also. measure in the prevention of rotavirus gastroenteritis [1-5.. Antibiotics in therapy of bacterial diarrhea [4. racecadotril and diosmectite have a favor. management of acute gastroenteritis in children in Europe. rotavirus vaccine is practically the only efficient Probiotics. The list of antibiotics to be used in the treatment of acute bacterial diarrhea is presented in Table 10 [4. Apart from contact with the diseased. 40. Johnson HL. Stanton BF. E. Perin J. ETEC. 46(Suppl 2):S81-122. [DOI: 10. Hoekstra JH. 19th ed. 8. 9]. Child 3. 106(33):539-47. and shortening of the disease course. Albano F. In: Kleinman RE. it is fully justified in [8. vention of Clostridium difficile enterocolitis. European Society for Paediatric Gastroenterology. Goulet O. Acute Diarrhea in Children Table 10.2298/SARH1512755R . as well as antiemetics (on- or manifested Salmonella bacteremia. 3. EIEC TMP/SMX 10/50 mg/kg per os in 2 doses 5 Ciprofloxacin 20–30 mg/kg per os in 2 doses 5–10 Metronidazole 30 mg/kg per os in 3–4 doses 5 Clostridium difficile Vancomycin 40 mg/kg per os in 4 doses 7 EPEC – enteropathogenic E. 2008. Also. loperamide in the prevention of rotavirus gastroenteritis [1. have advantage over standardly shortening of disease course and faster elimination of the designed preparations of the same type [49. Gendrel D. 2009. Diarrhoea: Why children are still dying and what can Pediatrics. Probiotics and their combination with prebiot. 2008. p. and partially Due to the high risk of adverse side effects. avoiding contact with the diseased Additional therapeutic measures is just as important [2. Farthing M.1097/MPG. Elliott EJ. Ashkenazi S.0539] [PMID: 19738921] 6. REFERENCES 1. able effect on the clinical course of the disease [4.

Pickering LK. editors. et al. Epidemiology of foodborne disease [DOI: 10.2012. Nelson Essentials of Pediatrics. Vuletic B. editors. Shelov S. children. 1994. J Pediatr [DOI: 10. Brno 1988. infection in children with acute diarrhea as detected by latex [DOI: 10. [DOI: 10.1155/2013/612403] [PMID: 23533446] Kliegman RM. Radlovic N. Hodges K. Garcia LS. Ichiyama T. 2004. Vuletić B. 2013. Mogna L. 2011.3748/wjg. 1998. 17. Goudie A.0b013e3182549092] [PMID: 22688142] et al. Miles JN. 2007.Srp Arh Celok Lek. Kajimoto M. 48. p. Szajewska H. Vuletic BP. World Gastroenterology Organization.1016/j.2013. New York: Churchill Livingstone. Guarino A. Radlović V. St Louis: Mosby. 24(5):557-61. Trisic B. Pediatrics. 44. Needham E. [DOI: 10. Guarner F. 141(5-6):325-8. ELISA and polyacrylamide gel electrophoresis. 2014. Bangladesh. p. Radlovic NP. Stanton [DOI: 10. Ramakrishna BS.2298/SARH1306325R] [PMID: 23858801] 21. Stanton BF. 2005. J Clin Microbiol.2004. editors. 1995. 2014. Fever and antipyretic use in children. et al. Bernard CN. Impact of psychological J Pediatr Gastroenterol Nutr. Gendrel D.69-90. Andorno S. Abraham B. maintain water and electrolyte balance in infants with ileostomy. Krause R. Ozkul A. Radlović N. Shelov S. 50. Foodborne Pathog Dis. 2011. Nelson Textbook of Pediatrics. 100(Suppl 463):35. acute gastroenteritis in children in Europe: update 2014. [PMID: 12154234] 51. Principles and Practice of Pediatric Infectious Disease. Schor NF. A joint WHO/UNICEF statement. Management of acute renal failure. Gangl A. 27. Recommendations for Rep. Hood K. p. 2nd ed. 307(18):1959-69. Dehydration in infancy and childhood. Stanton BF. 2(7):1751-73. Koc H. 1996. Clinical characteristics of rotavirus gastroenteritis in children. JAMA. and Nutrition/European Society for Pediatric Infectious 16. et al. Jenson HB. Simsek A. Nelson Textbook of Pediatrics. European Society for Pediatric Gastroenterology.2010-3852] [PMID: 21357332] 15. 1(1):4-21.2010. Fairbrother G.idc. et al. Musher BL. Gastroenterol Rep. Crit Rev Food Sci Nutr. Zaoutis TE. Clinical characteristics of benign convulsions with CG. [PMID: 16300036] 53(3):231-44. Balzarini In: Kliegman RM. 47. Srp Arh Celok Lek.i39.2010. rehydration therapy. [PMID: 25339801] 10-12 December 1994. Toxins.1084-7. 127(3):580-7.1038/ncpgasthep0167] [PMID: 16265204] 46. Philadelphia: 13. associated diarrhea: a systematic review and meta-analysis. Lo Vecchio A. In: Walker AW. Vujnovic Z. [DOI: 10. Farrar HC. Role of antidiarrhoeal drugs as adjunctive therapies for Acta Paediatr. Paripovic V. et al.1007/s11894-014-0376-2] [PMID: 24562469] 2012. In: Kliegman RM.242-9. Nuttall J. 2(5):216-22. Cheng CW. Gut Elsevier Saunders. [PMID: 10970380] in the United States. Musher DM. Microbes. In: Kliegman RM. Fassano A. Radlovic P. Gould LH. 16(3):376. Durie PR. [PMID: 21637030] 23(8):277-82. Orsello M. Shamir R.463-84. Masud T. Thomson A. Fever. 2010. Macrolides and ketolides: azithromycin. et [PMID: 22570464] al.1001/jamapediatrics. Shepherd V. 49:30-6. 2003. Deura L. [DOI: 10. In: Bernstein D. Garisch J. 165(5):451-7. Bian ZX. Paripović V. Geme III JW. Gut Microbes. Altindis M. Philadelphia: The increased efficacy of gastro-protected probiotics. [PMID: 1573500] stress on irritable bowel syndrome. Toltzis P.4161/gmic. Andrejić B. telithromycin. Yavru S. [PMID: 15235165] K. Curr Gastroenterol 43. Hamilton 24. Wang Z.441] [PMID: 23460123] Drugs. The management of diarrhoea and use of oral Health Technol Assess. Motoyama M. Arch Pediatr Adolesc Med. Nephrology: Fluid and electrolytes. Pagliarulo M. p. 25 years of ORS – Joint WHO/ICDDR. 2007. Curr R. Leković Z. 26. 9(5):365-72. Silverman A. rotavirus gastroenteritis. p. Probiotics for the prevention and treatment of antibiotic.3310/hta18630] [PMID: 25331573] 41. Treatment of Campylobacter enterocolitis in Organisation Global Guidelines: probiotics and prebiotics October children. Binder HJ. Roy CC. Rodicio MR. Ishrana odojčadi sa rotavirusnim gastroenteritisom.362-8. Tari R. Infect Dis Clin North Am. Djurdjevic J.2. 3rd ed. 2004. xi. [PMID: 17991336] composition of oral rehydration solutions for the children of Europe. Pathophysiology of body fluids and fluid therapy. Faure C. Pickering LK. 59(1):132-52. Stepanović R. Leković Z. parvum antigens in human fecal specimens using the triage 12. 2010.282] [PMID: 21199971] BF. 2010. 14:113-5. Garza JM. Duncan D.29-9-299] [PMID: 18765468] (including Clostridium difficile-associated diarrhoea) in care homes. 40. 1992.1177/0883073808327829] [PMID: 19168832] 10. Report of an ESPGAN Working Group. Simić D. Newberry SJ. 2014.v20. Ceri A. Section on Clinical Pharmacology and Therapeutics. Tang XD.14126] B Consultative meeting on ORS formulation – Dhaka. Behrman [DOI: 10. Carmagnola S. Shanman therapy in the second decade of the twenty-first century. Child Entamoeba histolytica/Entamoeba dispar. Gillespie D. [DOI: 10. Powell KR. Del Piano M. World Health Organization.1. by primarily non-gastrointestinal infections. [DOI: 10. Greenbaum LA. p. Zuckerman JM. Maher AR. Pavlović M. [DOI: 10.1080/10408398.573-610.11036] [PMID: 21327112] Hepatology. Clostridium difficile infection in hospitalized children 38(9):3337-40.212-42. 18th ed. 2013. Krejs GJ. 2013. Ristić D. [DOI: 10. 2010. Behrman M. Pediatr Rev. Milićević al. gastrointestinal tract infections. 2000. Gill R. 2011. Evaluation of the intestinal colonization by 28. Is microencapsulation the future of probiotic preparations? RE.1097/MPG. Fritzsche C. Philadelphia: 18. J Clin Gastroenterol. 18(3):621-49.1056/NEJMra041837] [PMID: 15575058] agglutination. Walker-Smith JA. prospective observational study of antibiotic-associated diarrhoea 2008. Watkins JB.0b013e3181ed0e71] [PMID: 20697290] 29.143(11-12):755-762 761 9. 2011. [DOI: 10. 19th ed.1001/archpediatrics. 2004. 2014. 2(2):120-3. 14. [DOI: 10. Detection of Giardia lamblia. 2013. editors. Principles of pediatric nutrition. Reisinger EC. Djurdjevic J.4. Fine RN. 2009. 11. 351(23):2417-27. et al. WHO/UNICEF. St Geme III JW. Schol NF. 2008. Rotavirus infections. Zoonoses Congress. Pediatric Clinical Gastroenterology. 46(6):468-81. 18(63):1-84. [DOI: 10.srp-arh. Qin HY. Hempel S. Carmagnola S. In: Behrman RE. Nelson Textbook of Pediatrics. Sartori M. Ashkenazi S. 41(6):590-4. 49. Oral rehydration 19. Sullivan JE. Mendoza MC. 2013. 2012.4161/gmic. 167(6):567-73. Philadelphia: WB Saunders Comp. Mladenović M. 20(39):14126-31. 2005. Am Fam Physician. 1985. gastroenteritis at a pediatric gastroenterology department. Philadelphia: Williams & Wilkins. parasite panel enzyme immunoassay. Nylund CM. World J Gastroenterol. 2015 Nov-Dec. 2011.0000000000000375] [PMID: 24739189] outbreaks caused by Clostridium perfringens. 10(2):131-6. experience. microencapsulated probiotic bacteria in comparison with the same fluids and electrolytes. Clostridium difficile Infection in Elsevier.3507] 42. p. Grass JE. mechanisms. Probiotics for Antibiotic-Associated Diarrhoea (PAAD): a 39.18. Approach to diagnosis and management of 32. Wood F. Prober Furukawa S. Int J Pediatr. 2nd ed.2. Riaz QU. 1990. Intestinal infections. [DOI: 10. Whyte DA.1542/peds.rs .010] [PMID: 15308279] [DOI: 10. editors. Contagious acute gastrointestinal 33. Ristić D. materials for probiotic stability. Radlović N. Mahon BE.15784] 30. 72(9):1739-46. Acute renal failure in children. Greenbaum LA.1001/jama. [DOI: 10. 36(1):82. Elsevier. G Mal Infett Parassit. Eliakim R. Khan AG. Food poisoning and Diseases evidence-based guidelines for the management of Staphylococcus aureus enterotoxins. Radlovic N. 22.3390/toxins2071751] [PMID: 22069659] Gastroenterol Nutr. Radlovic NP. 36. Hrana i Gastroenterol Hepatol. Pediatric Gastrointestinal Jovanovic I. J Clin Gastroenterol. uncoated strains. Stewart CL. Milosavljevic S. 2010. Brown I. Finberg L. Sellin JH.2012. In: Long SS. Andrejic B. et 25. 2013:612403. 4th ed. Drug-induced diarrhea. p. [DOI: 10.1097/MCG.524953] [PMID: 23215997] www. Young GP. 19th ed.1097/MCG. N Engl J Med. [DOI: 10. Argudin MA.04. 2011.1089/fpd.1316] [PMID: 23379281] RE. Radlović N. Significance of the application of oral rehydration solution to 20. 44(Suppl 1):S42-6. 2002. Kaskel FJ. 2000. Shiraishi M. Recent trends and applications of encapsulating 31. United States. Lukac M. Trisic B. and Cryptosporidium Care Health Dev. Pediatr Rev. Diarrhea caused 45. editors. 38. editors. Abstracts. J Child Neurol. Matsushige T. 35. JAMA Pediatr. Committee on [DOI: 10. Alagille D. 23. Nat Clin Pract et al. 2011. Hamilton: BC Decker Inc. Behrman RE. The prevalence of intrahospital-acquired Rotavirus 34. Sammons JS. Berenji Indian Pediatr. RJ.1. Del Piano M. et al. clarithromycin. Milosavljević S. Maintenance and replacement fluid therapy.1542/pir. 29(9):299-306. Infectious diarrhea: cellular and molecular 37. ishrana. 42:683-5. Lewy JE. Rotavirus gastroenteritis in children: our clinical Disease. Shimizu RY. Cohen MB. World Gastroenterology J. acute diarrhoea in children. Ballarè M.

те се ин­фек­ци­је (ви­ру­сне и бак­те­риј­ске). 2 Универзитет у Београду.2.3. Ње­ни при­мар­ни узро­ци су га­стро­ин­те­сти­нал­не спа­змо­ли­ти­ка је бес­по­треб­на и по­тен­ци­јал­но ри­зич­на. ан­ти­па­ра­зит­не ле­ко­ве уко­ли­ко су за­сту­ се на­глом по­ја­вом три или ви­ше теч­них или обил­них сто­ пље­не ин­те­сти­нал­на лам­бли­ја­за и аме­би­ја­за. Биљана Вулетић4. а ре­ђе али­мен­тар­не ин­ не са­ве­ту­је код де­це с акут­ном ди­ја­ре­јом. и про­би­о­ти­ке. ети­о­па­то­ге­не­за. Факултет медицинских наука. Медицински факултет. Београд. Србија. из­у­зи­ма­ју­ћи ан­ти­пи­ре­ти­ке ако је де­те и глав­ни узрок де­хи­дра­та­ци­је у деч­јој до­би. Душица Симић2. Бу­ду­ћи да су де­хи­дра­та­ци­ја и не­га­ти­ван ну­три­тив­ни би­ланс глав­не ком­пли­ка­ци­је акут­не Кључ­не ре­чи: акут­на ди­ја­ре­ја. Београд. Београд.762 Radlović N. При­ме­на ан­ти­е­ме­ти­ка. ли­ца днев­но у тра­ја­њу од се­дам до де­сет да­на. Дру­ Акут­на ди­ја­ре­ја је нај­че­шћи га­стро­ин­те­сти­нал­ни по­ре­ме­ћај ге те­ра­пиј­ске ме­ре. Нај­че­шће по­га­ђа де­цу у пр­вих пет го­ди­на по ро­ђе­ упо­тре­бу ан­ти­би­о­ти­ка и црев­них ан­ти­сеп­ти­ка у ле­че­њу бак­ њу. нај­ду­же 14 рет­ко су по­треб­не. Србија. ја­сно је да ће на­док­на­да гу­бит­ка те­ле­сне теч­но­сти ка. 4 Универзитет у Крагујевцу.3 1 Академија медицинских наука Српског лекарског друштва. Зоран Лековић3. Србија КРАТАК САДРЖАЈ и од­го­ва­ра­ју­ћа ис­хра­на чи­ни­ти осно­ву ње­ног ле­че­ња. Крагујевац. ток­си­ка­ци­је и дру­ги фак­то­ри. Владимир Радловић3. То се при­мар­но од­но­си на не­кри­тич­ку да­на. Acute Diarrhea in Children Акутна дијареја код деце Недељко Радловић1.2298/SARH1512755R View publication stats . ди­јаг­но­сти­ ди­ја­ре­је. Ма­ни­фе­сту­је ви­со­ко фе­брил­но. et al. 3 Универзитетска дечја клиника. ле­че­ње Примљен • Received: 12/03/2015  Прихваћен • Accepted: 06/04/2015 doi: 10. ан­ти­ди­ја­ро­и­ка и три го­ди­не. Србија. а по­себ­но одој­чад у дру­гом по­лу­го­ђу и де­цу уз­ра­ста до те­риј­ских ди­ја­ре­ја.