Pediatric Infectious Diarrhea and Dehydration

Abstract

Diarrhea is a common emergency department (ED) complaint, leading to more than 1.5 million outpatient visits and 200,000 hospital admissions in the United States alone. Although concomitant dehydration also exists in some cases, there are no standard clinical criteria to aid in identifying those children who merit intravenous resuscitation. Current pediatric volume repletion guidelines are based primarily on the estimated degree of volume depletion per the World Health Organization, Centers for Disease Control and Prevention, and American Academy of Pediatrics criteria. These practice guidelines stratify patients into mild (3 to 5% volume depletion), moderate (5 to 10% volume depletion), and severe (> 10% volume depletion). The vast majority of pediatric patients presenting with nausea, vomiting, and/or diarrhea suffer from virus-mediated enterocolitis and require no testing or intravenous fluid resuscitation due to the self-limiting nature of these syndromes; rotavirus and Norwalk virus are two of the most common causes of infectious diarrhea in both developing and developed countries. Although bacterial pathogens rarely cause infectious colitis, children who present with more severe symptoms, including fever, bloody stool, and significant abdominal discomfort, warrant additional diagnostic evaluation. Obtaining a careful history, including exposures to livestock, well water, travel, and antibiotic use, as well as recent intake of undercooked meat, is key to identifying patients who may be at higher risk for bacteria-mediated illnesses. Tables identify common diarrheal pathogens, diarrheal subtypes, and clinical abnormalities associated with volume depletion and more severe syndromes, such as hemolytic-uremic syndrome. This review contains 5 figures, 10 tables, and 80 references. Key words: Clostridium difficile, dehydration, diarrhea, gastroenteritis, hemolytic-uremic syndrome, pediatrics