Acut

edi
arr
heaandDehy
drat
ioni
nchi
l
dren
2018-2019
PEDIATRI
CDEPARTMENT
FACULTYOFMEDI CINE-TAIZUNIVERSI
TY
Dr.JamalAl -
Mashwal
i

DEFINITI
ON:
1-Acutediar
rhea,coul
dbydefinedasi ncr
easedtot
aldai
l
ystoolout
putwi
thincreasedwater
content
,itsr
esult
sinlar
gel ossesofwaterandel
ectr
oly
tes,
foraper
iodoflessthan10-14
days.
 I npract
ice,l
oosewaterystoolsoccurr
ing4ormoreti
mesperdayisgenerall
yconsi
dered
abnormal.

2-Onet
imedai lyexcessst oolwhi chcont ai
nblood, mucous, pur
ulent.
 I
nbr eastfedheal t
hyinfant s(fir
stmont h)stoolisoft
ensof tandrunny
,andfrequent
(normallymayhav e5-10t imesperday ).
 Anybabywhohasmor et hanonest ool perfeedingshoul
dal sobesuspect
edofhav i
ng
diarr
hea, evenifthi
sisasuddenchange.
 Acutedi ar
rheathatlast slesst han10- 14day s.
 Subacut ediarr
hea(per sistent)thatlastbet ween2–4weeks
 Chronicdiarrheapersistsf orlongert han4weeks.

EPI
DEMILOGY
 Acut edi arrheaisav erycommonheal t
hproblem andr emainsoneoft hemostcommon
diseasesamongchi l
dren.
 Acut edi arrheaisresponsiblefor10%ofal lhospi
talizati
onschildr
enlesst han5yearsofage
especi allyduringthefirstyearofl
ife.
 Wor ldwi de, ev
eryyearabout2. 5bil
lioncasesofdi ar
r heaoccursinchi
ldren,mostcommonl y
indev elopi ngcountri
es.
 Appr oxi mat el
y3-5mi l
li
ony oungchi l
drendieeachy earasaconsequenceofdehy drati
on
from di arrhea.
 Acut edi arrheacanoccuratanyt i
meoft heyear,
butv i
rali
nfecti
onsaremostcommon
duringt heWI NTERmont hsandbact er
ial
inf
ecti
onsoccurmor efr
equentlyintheSUMMER
mont hs.

Fact
orst
hatpr
edi sposechildrentoi nf
ect
ionwithenteropathogens
 Youngage( gestation<37weeks, l
owbi rt
hwei ght)
 I mmunedef ici
ency
 Lackofbr east-feeding
 Poorhy giene::
-Infecti
onpr obablyoccursviafecal-
oralt
ransmi ssionwit
hfoodandwater
especiall
yinchi l
drensixmont hstotwoy earsofage
-Manyent eropathogensmaybet ransmitt
edbyper son-
to-
personcont
act
,

suchasshi
gel
l
a,E.col
i
,Gi
ardi
alambl
i
a,E.hi
stol
.orent
eri
cvi
ruses.

 Mal
nutr
it
ion
 Measl
es

1
  Tr aveltoanendemicar
ea
ETI
OLOGY:Thedi arr
heacouldbe:
Inf
ect
ious
Non-i
nfect
ious

1)I
nfect
iousdi
arr
hea:
Ther
eisawi
dev
ari
etyofent
eropat
hogenst
hatcausesdi
arr
hea,
incl
udi
ng:
VI
RUSES:Vir
aldiarrheaismostcommoni ny oungchil
dren.
 Rotav i
rus:common- gr
oupA-40-50%,B, C–r ar
ely
Manyot herv i
rusescancausechil
dhooddiarrheaaswell
,i
ncl
udi
ng:
 Entericadenov i
rus
 Norwal kv i
rus
 Astrovirus-Pest i
vi
rus-Coronavir
us-Calici
v ir
us
 Rot
avi
rusandadenov i
rusarepar
ti
cular
lypreval
enti
nchi ldr
eny
oungert
han2year
s.

BACTERI
A:I
mpor tantbact erialpathogensofacut ediarrheai
ncl
ude:
 PathogenicEscher i
chiacol i
- Ent erohemor r
hagicE. coli(STEC)(pr
otot
ype-0157:
H7)
- Ent erotoxigenicE.coli(ETEC)
- Ent eropathogenicE. coli(EPEC)
- Ent eroinvasiveE.coli(EIEC)
- Ent eroaggr egati
veE. coli(
(EAEC)
 Shigell
a
 Salmonel l
a
 Campy l
obacterj ejuni
 Yersini
aent erocol i
tica
 Clostri
dium difficil
e
 Vibri
ochol era( sever ediarrheainepi demi cs)
- Yer
sini
aent
erocol
i
ticat
ypi
cal
l
yinf
ect
schi
l
dreny
oungert
han1y
ear
.
- Clost
ridi
um di
ffi
ci
lei
nfecti
onoccur
sthemostcommoni
nchi
l
drenwhohav
erecei
ved
anti
bioti
csdur
ingtheprecedi
ng3weeks.

PARASI
TES:Commonpar asit
iccausesofdi
arr
heai
ncl
ude:
 Giardi
alambli
a
 Entamoebahistol
yti
ca
 Cryptospor
idi
um par
vum –commoni ni
mmunodef
ici
entpat
ient
s
-Giar
diaorganismscancausei nter
mi t
tentdi ar
rheaandfatmalabsorpt
ion.
(
2)Noninf
ecti
ousdi arr
hea: Therearemanynoni nfecti
ouscausesofdiar
rhea;i ncl
udi
ng:
 Foodpoisoning(food- borne) 
:
- Staphlococcusaur eus-Sal l
monel l
a -E.col i
- Clostri
dium per fri
ngensandCl ostri
dium botul
inum
- Bacill
uscer eus
 Foodall
ergi
es: -Speci f
icmi l
kall
ergyininfant s
 Enzymesdeficiencies( asinlact
oseintolerance)
 Medicat
ions,especi all
yantibi
oti
cs
 Toxi
csubstances.

2
  Malnutration.
 Crohndi sease, ulcerati
vecoli
tis,
mot i
li
tydisorders.
 Malabsor ption:Disacchar i
dasedef i
cienci
es, pancr eati
cinsuffi
ciency,chol
est
asi
s,cel
iac
di
sease, cy sti
cf i
brosis.
 Metaboliccauses( Endocri
nopathies):hyperthyroidism,Addisondi sease.
 Anatomi cdef ects:intussuscepti
on,Hi r
schspr ungdi sease,shortbowel syndr
ome,microv
il
lus
at
rophy.
 Neoplasms: neurobl astomas,ganglioneuromas, Zolli
nger-
Ell
isonsy ndrome

PATHOPHYSI OLOGY
Theacut
einfectiousdiar
rheacoul dbeinflamatoryornoninf
lamatory:
 Inflamat or
y-(usuallycausedbybact er
ia)
,ther
eisdirectintesti
neinvasionorcy t
otoxi
ns
productionbybact eri
a.
 Noni nflamatory-causedbyent erot
oxinproducti
onbysomebact er
ia,destruct
ionof
vi
llus(surf
ace)cellsbyv i
ruses,andadherenceortranslocationbybacteria.
SECRETORYDAIRRHEA:
- Bacteri
a–Vi br
iochleraeorE.col
-enter
otoxi
geni
c…..
- Bindingtoareceptorontheepit
heli
um surf
aceofthebowel
- Re pr
oducti
on-Enterot
oxi
n
- Attackst heenterocytes-dest ructi
onoft hebr
ushbor derfunction–sev eremucosaldamage
- Sti
mul at
ionofCy cl
ic-
AMPpr oductininthemucosal cel
ls
- Mal absorptionofelectrolyt
esandwat er-Decreasedabsorptionandi ncreasedsecr
eti
onint
he
gutl umen-f lui
dsecretionoccur sbyt heextr
usionofchlorideionf r
om thecellsoft
hecry
pt
andi nhibit
ionofabsor ptionfrom vil
li
- ther esult
antlossofwat erandel ectr
oly
tes(Na,K,Cl)inthestool canber api
dandmassive.

CDAI
OSMOTI RRHEA:
- Vi
ral
inf
ect
ion-
Rotavir
us…..
- Bi
ndi
ngtoareceptorontheepi
thel
i
um sur
faceoft
hebowel
- Toxins-Att
acks(invasion)t heent erocy t
esoft hev i
ll
i
- Epit
heli
alcel
ldestructi
onwi thshor t
eni ngoft hevil
li
- Incr
easedproductionofsecr etorycrypt -
li
kecells(thi
scell
shavegreat
lyr
educedabsorpt
ive
surf
ace)andreduceddi sacchar i
dasesact ivi
tyinthebrushborder
.
- Malabsorpt
ionofcar bohy dr
at e(Lactose)
- Lossofnormal small i
ntestinal f
unctionwi thactivesecret
ionoff
lui
dsandelect
rol
ytes–
diar
rheawithosmot i
cl ossoff reewat erintothegutlumen
 Stool
lossesofbicar
bonat
eandpot
assi
um occuri
nbot
hsecr
etor
yandmal
absor
pti
ve
(osmoti
c)diar
rhea.

Di
ff
erent
ial
diagnosi
sofmechani
smsofdi
arr
hea
St
ool secr
etor
yDi
arr
hea osmot
icdi
arr
hea
St
ool
(Na) >70mEq/
l <70mEq/
l

Fecal
pH >6 <6

Reduci
ngsubst
ances (-) (+)

St
ool
vol
. >200ml
/24hr <20ml
/kgday

3
 Comment per
sistdur
ingf
ast
ing st
opswi
thf
ast
ing

Ser
um (
Na) i
sot
oni
cdi
arr
hea hy
per
toni
cdi
arr
hea

Def
ect absor
pti
on,
secr
eti
onel
act
rol
yte l
act
osedef
ici
ency

Com.Et
iol
o Bact
.enterotoxi
c(Chol
era,
E.col
i
, Vi
ruses,
st
aphyl.enterat
is)

CLI
NICALPRESENTATI
ON
Chi
l
drenwi
thdi
arr
heacommonl
ypr
esentwi
thcompl
aint
sof:
- Suddeni
ncr
easei
nthef
requencyoft
hest
ool
s.
- Wat
eryst
ool
s,bl
oodyormucusst
ool
s:5-
10mot
ionsormor
eperday
.
- Foul
-smel
l
ingst
ool
s.
I
nsomeinst
ances,
aff
ect
edchi
l
drenmaybeaccompani
edby
:
- Cr
ampyabdominal
pai
n
- Nausea,
vomi
ti
ng.
- Poorf
eedi
ng(
anor
exi
a),
Lossofappet
it
e
-f
ever
,ir
ri
tabi
l
ity
,sei
zur sei
es( zur
escanoccurwi
thanyi
nfect
iont
heyar
emor
e
char
act
eri
sti
cofShi
gel
l
osi
s).
- Abdomi
nal
dist
ent
ion.
- Si
gnsandsy
mpt
omsofdehy
drat
ion.
- Si
gni
fi
canti
ncr
easesi
nper
ist
alt
icact
ivi
ty(
bowel
sounds)
.

Cl
i
nical
pict
ureofdy
sent
ery
:(Shi
gel
l
a,Sal
monel
l
a,E.col
i–Ent
eroi
nvasi
ve–Ent
erohemor
rhagi
c,
Campy
lobact
er,
E.hi
stol
)
o Fev
er
o Abdomi
nal
pai
n
o Tenesmus
o Ur
gency
o Bl
oodyst
ool
o Bl
oodandpuscel
l
sint
hest
ool
.

Wat
erydi
arr
heaandv
omi
ti
ngi
nchi
l
drenl
esst
han2y
ear
sofagemostl
i
kel
yrepr
esentv
iral
gast
roent
eri
ti
sandt
her
efor
edonotr
equi
reant
imi
crobi
alt
her
apy
.
DEHYDRATION
Dehy
drat
ion:
Ist
hel
ossofwat
erandel
ect
rol
ytef
rom t
heext
racel
l
ularf
lui
ds.

4
  Dehy
drat
ioni
sthepri
ncipal
amajorcauseofmor
bidi
tyandmor
tal
i
tyi
ninf
ant
sandchi
l
dren.
 Dehy
drat
ioncanbe:
Mild,Moder
ateorSever
e

Ty
peofdehy
d. mi
l
d Moder
ate Sev
ere
G.condi
ti
on wel
l
,al
ert r
est
less,
irr
it
abl
e l
ethar
gic,
drowsy
,fl
oppy
Vi
tal
signs:
Systol
i
cBP: nor
mal normal(
ortho.
) ver
yloworabsent
Heartrat
e : nor
mal sl
ightel
evati
on( or
th.
) ver
yelev
ated
Respir
ati
on: nor
mal deep,mayber apid deepandrapi
d
Radi
alpul
se n.r
ate&s r
api
dandweak f
eebl
e,r
api
d,i
mpal
pabl
e
Ey
es nor
mal sunken v
erysunken,
dry
Ant
eri
orf
ont
anel nor
mal Depr
essed sunken
Tear
s pr
esent absent absent
Mout
handtongue nor
mal
=moi
st dr
y v
erydr
y
(
Mucousmembr anes)
Thi
rst dr
inksnor
mal
l
y t
hir
sty
,dr
inkseager
ly unabl
etodr
ink.apat
hy
Ski
nel
ast
ici
ty nor
mal r
etr
act
ssl
owl
y r
etr
act
sver
ysl
owl
y
Ur
ineout
put nor
mal ol
i
gur
ia(
<1ml
/kg/
hr) anur
ia
B.
Wei
ghtl
oss <5% 5-
10% >10%
B.f
lui
dLost)
ml/
kg/
b.w.
) <50 50–100 >100hy
pov
olemi
cshock

oIsot
onicdehy
drat
ion:
(thelossesofsodi
um andwat
erar
epr
opor
ti
onat
e),
iti
sseeni
n
approxi
matel
y70-80%ofchil
drenwit
hdiarr
hea.
o Hyper
toni
cdehydrat
ion:(
greaterl
ossesofwat
ert
hanofsodi
um)
,occur
sin appr
oxi
mat
ely15-
20%ofall
pati
entswithdi
arrhea.
o Hypot
oni
cdehydr
ati
on:(great
erl
ossesofsodi
um t
hanofwat
er)
,occur
sinappr
oxi
mat
ely10-
15%ofal
lpat
ient
swithdiarr
hea.

PHYSI
CALEXAMI
NATI
ON:
1-Thegeneral
Appear
ance.
theassessmentoft
hechi
ld'
sgener
alappear
ance(
looki
l
lort
oxi
c).
2-Hi
story-general I
nformation.
Itisimpor t
antt oknowt heageoft
hechil
dandthepresencesy
mpt
omssuchf ev
er,
vomit
ing,
pai
nandot her……. .
 Feedinghistory.
 Recentantibiot
ictherapyorot
herdr
ugs.
Itisalsoof tenhelpfult
oknowwhetherornotot
herf
ami l
ymember
sorpat
ientcont
act
shav e
beenaffected.

St
ateofhydr
ati
on
 Assessever
ypat
ientwi
thdi
arr
heaf
or:
signs,
sympt
omsandsev
eri
ty.

5
  Assesst hedegreeofdehydr
ati
on.
 Carefulexaminati
onoftheski
n,mucousmembranes,eyes,
andfontanel
l
esforsi
gnsof
dehydration.
 Small i
nfantsmaydevelopdehydr
ati
onandel
ect
rol
yteimbalanceasearl
yas24hraft
er
onset.
4-
Speci
fi
cinformati
onabout::
St
ool:
durati
on,frequency
,vol
ume,cont
ent(wat
er,mucousandbl
ood)
,col
or,
odor
.
Ur
ine:t
hefrequencyandv ol
umeoftheuri
neoutput
.

5.I
sthereafocusofi nfect
ion:
Inf
ant
s,canhav
edi
arr
heaassoci
atedwi
thf
oci
ofext
rai
ntest
inal
i
nfect
ionsuchas:
 UTI
 Meni ngit
is
 Pneumoni a
 Mal ari
a
 Hepat i
ti
s
 Peritoni
ti
s
LABORATORYEXAMI NATION
1.Stool anal
ysis:forBl
ood, Leukocy tes, Eryt
hrocy t
es, Ov a,parasit
es, PhandReduci ngsubst ances.
Theset estsmayhel pinthedeci sionast owhet herornott hediarrheai sduet oinfecti
onorsome
otheretiology.
 Thepr esenceofBlood, Leukocy tesander yt
hr ocy tesinst oolspecimensar emor el i
kelyto
beassoci atedwit
hI nflammat orydi ar
rheas( dy sent ery)
.
 Fewcel l
sofLeukocy tesar eusual lyseeni nthet oxigenicdiarrheas( foodpoi soning).
 Thepr esenceofEosi nophi lsshoul draisesuspi cionofal ler
gyorpar asit
icinfecti
on.
 LowpH( lessthan6)andr educi
ngsubst ancesar eseeni ncar bohy drat
emal absorpti
on.
 TheRot azyme( R)testi susef uli
ndet ectingt hepr esenceofr otavi
rus.
2.Stoolcultur
es:
 Isr ecommendedf orpati
entswithsev ereorbl oodydiarrhea.
 Maybeusef ulfordiff
erenti
ati
ngbact erialfrom v i
ralgastroenter
iti
s.
3.Compl eteBloodCount( CBC).
 TheCBC( l
i
ttl
ehelp)butmaybeusef ulindet ecti
onofbact eri
alinfecti
on.
 ESR, CRP-bacteri
al i
nfect
ion.
4.Serum electr
olyt
es:(Na,K,Ca)Fordet ection:typeofdehy drati
on( Na).hypokal
emi
a,
hypocalcemia.
5.Bloodgases.-Fordet ecti
onofmet abolicaci dosis.
6.Bloodur eaandcreati
nine:withsuspectedr enal failur
e(oli
gur i
a,anuri
a).
Badgeneral
condition:f
ever,
highl
eukocy
tes:
-Bloodcultur
e-LP( CSF)
-Chestx-ray
-Urineex.+urinecul
tur
e.
TREATMENT

Or
alRehy
drat
ion:

6
-Oral
Rehydrat
ionisoftentheoptimalmethodforthetreatmentofacutediarrhea associ ated
wit
hmi l
dandmoder atedehy dr
ati
on.
-Oral
Rehydrat
ionSoluti
on( ORS)Recommendedbyt heWHO.
-Oral
Rehydrat
ionissaferandef f
ecti
veinpati
entswithacutediarr
hea,andmor ephy
siol
ogict han
i
ntr
avenoustherapy,becauseenter
icnutr
it
ionstimulat
esintesti
nalcel
lrenewalinseveral
ways.
.
Composi t
ionofOralRehydrat
ionSolut
ions-MEq/ L(mmol /l
)

Sol
uti
on Na+ K+ CL- Base Sugar Osmol
ali
ty(
mOsm/
l)

WHOORS 90 20 80 HCO3 Gl
ucose111(
2%) 330

Pedi
aly
te 45 20 35 Ci
tr
ate Gl
ucose2.
5% 269

-Glucoset heusei nORS,becauseitfacil

i
tat
est hetransportofsodium acrosst
hebowel
wall.
-Zi
ncsuppl emantati
ons;Oralzi
nc10-20mg/ dayfor10-14day stoallchil
drenbel
ow5yearswit
h
di
arrhea.
-Beforether apyi
sbegun, t
hedegreeofdehy drati
onshoul dbecli
nical
lyassessed.
-Thedegr eeofdehy drat
ionindi
cat
est heneedf or:
1-Rehydrati
on
2-Maintenance
3-Replacementofstoollosses
1-REHYDRATI ON:
 Duri
ngt hefi
rst4-6hr:giv
ent opat ientwi
thmil
ddehydrati
onORS50ml /
kgand100ml /kgto
pati
entwithmoder atedehydration.
 Aft
er4- 6hr.
,i
fsignsofdehy drationpersi
st,
rehydr
ati
ontherapyshoul
dber epeat
edunt il
dehydrati
oniscor r
ected.
 I
nfantswithnosi gnsofdehy drationdonotneedrehydr
ati
on.Proceedwithmaintenance
andreplacementofst ooll
osses.

2-MAI
NTENANCE:
 Aft
errehydrat
ion,Inf
antscanconti
nuebr
eastfeedi
ng,
inotherchi
l
ds,thei
rusual
formula,
mil
k,olderchi
ldrenthei
rusualdi
ets.
 Fat
tyfoodsorf oodshighinsi
mplesugar
s(includi
ngj
uicesandcarbonat
edsodas)shoul
d
beavoided.

3-REPLACEMENTofst
ool
losses
 Chil
drenwi
thmi
l
ddiar
rheacanbegi
ven100ml
/kg/
24hr
.ofORSUnt
ilt
hedi
arr
heast
ops.
 I
fthest
ool
out
putv
olumei
sunknown,
repl
acementofst
ool
lossesofORS10ml
/kgf
or
eachdi
arr
heal
stool
.
 (
50-
100ml
forchi
l
dren<2y
ear
s),
(100-
200ml
forchi
l
dren≥2y
ear
s)
Per
sist
entvomi
ti
ng
 Manypat i
entswit
hacut
ediar
rheahaveconcomit
antvomi
ti
ng.
 Butmor echi
ldr
enscanbesuccessf
ull
yrehy
drat
edift
heORS:

7
 -i
sgiveninsmallv ol
umes(5-10ml )
-i
sgivenslowlyviaaspoon,sy r
inge,cup
-admini
steredevery1-2minuteswi t
hagr aduali
ncr
easeintheamount
.
Nasogastri
ctubef orr
ehydrati
onofORSsol uti
oncanbehelpfulf
orthechi
l
dwho i
sper
sist
vomiti
ng.Give:20-
30ml /kg/
1hrf or6hour s(tot
al:
120ml /
kg)

I
ndi
cat
ionst oI.Vflui
dther apy:
 Sev erediarr
hea>10ml /kg/1hr
.
 Sev eredehydrat i
on(>10%)
 Shock
 Lossofconsci ousness
 Stomat iti
s
I ntesti
nal di
stention
 Per si
stentvomi ti
ng
 Chi l
drenwhocannott oler
ateoral
flui
ds.
I
ntrav
enousRehydrati
on:isof t
ent heopt
imalmethodf
ort
het
reat
mentofsev
eredehy
drat
ion.
I
tisgivenov
er24hour sandi tincl
udes3steps:
1-Shocktherapy(30-60mi n).
2-Defi
citt
herapy(ov er12hr )
,
3-Maint
enacet herapy(over12hr)

SHOCKTHERAPY: (canuul
a)starti
.vfl
uid
Ringer
,sl
act
ateor0.9%normal sal
i
ne20- 30ml/
kg/30-60min.
(Repeatt
hefl
uidi
ftheradi
alpulseissti
llver
yweakornotdetect
abl
e)

DEFICITTHERAPY
Severedehydration(
thefir
st12hours)
Ri
nger,slact
ateor0.9%Nacl40-60ml /kg/4hr.
5%glucose+0. 9%Nacl(1:
1)70ml / kg/8hr
+
0.5ml/ kg15%KCL( pot
assi
um chl ori
de)
1-
2ml /kg/sodium bi
car
bonate(ifsev ereaci
dosi
s)

SEVEREDEHYDRATI
ON(second12hour
s)
5%glucose+0.
9%Nacl(
1:1)70ml/
kg/12hr
+0.5-1ml/
kg15%KCL
Dur
ingt
henext24hour
s,or
alr
ehy
drat
ioni
str
ied.
Maint
enacet
herapy(ov
er12hr):
Flui
dRequir
ementfr
om bodywei
ght
Upto10kg--
--
-100ml /kg/
day
10-20kg --
---1000ml +50ml/
kg/dayforeachkgabov
e10kgofb.weight
Above20kg--
--1500ml +20ml/kg/
dayforeachkgabove20kgofb.wei
ght
Theroutineuseofl act
ose-fr
eef or
mulasininfantswithdi
arr
heai
sunnecessar
y.
80%ofchi ldrenwit
hacut ediar
rheatol
erat
ef ull
-st
rengthmil
kwel
l
.
Complicat
ionsofsev erediarr
hea:
1.Dehy drati
on
2.Shock

8
 3.Acuterenal f
ail
ure
4.Metabolicacidosis
5.Hypokalemi a
6.Hypocalcemi a
7.Conv ul
sions
8.Persist
entdiarrhea
9.Malnutri
tion
10.Lactoseintol
erance

ANTI
BIOTI
CTHERAPY
 Mostacut edi
arr
heali
nchil
drenar
eself
-l
imit
ingandr esol
v ewi
thi
naf ewday
s.
 Anti
bioti
cther
apyshouldonl
ybeusedforspecif
icindicat
ionsBecause
Mostdiarr
heainchi
ldr
enisnotduetobact
eri
alinfect
ion.

I
ndi
cat
ionforantibi
oti
ctherapy
:
 Infants<3mont hs.
 Dysent erysymptomati
c.
 Mal nutri
ti
on.
 Diarrheaassociatedwi
thfoci
ofext
rai
ntest
inal
inf
ect
ion.

Or
gani
sm Dr
ug Dose
-Fever>38Cor Cot
ri
moxazol 5-
10mg/kg/
24hr2x3-5days
-Bloodydiar
rhea Cef
tri
axone i
.v
.50-
100mg/kg/24hr1-
2x
-I
ncreasedpuscell
s Cef
otaxi
me i
.v
.75-
100mg/kg/24hr3x
Shigell
a
Salmonel l
a Cot
ri
moxazol 5-
10mg/kg/
24hr2x3-5days
E.Col i Cef
tri
axone i
.v
.50-
100mg/kg/24hr1-
2x
Vibri
oChol erae Cef
otaxi
me i
.v
.75-
100mg/kg/24hr3x
Yersini
aent erocoli
ti
ca
Compy l
obacerj ej
uni/col
i Er
ythromy ci
n 20-
50mg/kg/24hr2-
4xFor5-
7day
s
Clostri
dium diff
ici
le >10y e.Metroni
dazol 3x/
day
Vancomy cin 30mg/kg/
24hr4xfor10days
<10y e.Vancomy ci
n 40mg/kg/
24hr4xfor10days
Giardi
alambl
i
a Metronidazol 3x/
day
Entamoebahist
oly
tica

ANTI
DIARRHEALMEDI CATIONS:
- Theuseofant i
diarrhealmedicat
ionstost opdiar
rheasuchas:Antimoti
li
ty(l
oper
ami
de)
,
arenotrecommendedi nchil
drenwithacut edi
arrhea,
becauseav ai
labl
edatadonot
demonstratet
heiref f
ecti
venessinreducingdiarr
heav ol
umeordur ati
onandmayenhance
bacter
ialpr
oli
fer
at i
onandt oxinabsorpt
ionbypr omotingreducedgutmot i
l
ity
.

- Si
deef
fect
sincl
udi
ng:
il
eus,
aci
dosi
s,hy
per
chl
oremi
a,dr
owsi
nessandnausea.