167 - Pediatric Infectious Diarrheal Disease and Dehydration

Abstract

Acute infectious diarrhea is common around the world. It can have significant morbidity and mortality especially in underdeveloped countries. In the United States and Europe, most cases of infectious diarrhea are viral with rotavirus and norovirus being the most common viruses. Bacterial diarrhea is less common with most cases in the United States caused by nontyphoidal Salmonella. Other common infectious bacteria include Shigella, Campylobacter, Escherichia, Clostridioides, Staphylococcus, and Vibrio species. Parasitic diarrhea is rare cause of infectious diarrhea in children in the United States. Cryptosporidium, Giardia intestinalis, and Entamoeba histolytica cause most parasitic diarrhea in the developed world. Patients with uncomplicated diarrhea do not require additional testing or stool cultures. Fecal leukocytes indicate the presence of invasive disease and should be followed with stool cultures. Stool ova and parasite evaluation should be considered for patients with travel to endemic areas. Antibiotics are not needed in viral gastroenteritis or in most cases of uncomplicated bacterial gastroenteritis in healthy patients. Zinc supplementation helps reduce the duration of diarrhea in zinc-deficient children but has unclear effectiveness in patients at low risk for zinc deficiency. Infectious diarrhea can present with significant dehydration and electrolyte abnormalities. Clinical dehydration scales can assist in the diagnosis of dehydration, but urinalysis and ultrasound have limited utility. Mild to moderate dehydration can be treated with oral rehydration therapy. Severe dehydration should be treated with rapid intravenous normal saline infusion to restore perfusion and slow correction of sodium derangements.