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Pediatric Diarrhea with Dr. Jay Larmon

Non-bloody diarrhea with or without a fever usually is a viral process, and only requires supportive care (i.e. hydration, etc). These patients typically are able to be rehydrated and discharged home with reassurance/return precautions to the parents. Now bloody diarrhea with a fever is not as simple. This presentation has a higher probability to be bacterial as opposed to viral. How does this change our management? Well, patients have a greater potential to be sicker, and even though there is a higher chance of a bacterial infection these patients should NOT be started empirically on antibiotics. Why no antibiotics? Antibiotics can increase the risk of hemolytic uremic syndrome (HUS)…

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 PEM Playbook – Diarrhea

Non-bloody, febrile — most likely viral Non-bloody, afebrile — may be viral Bloody, febrile — likely bacterial Bloody, afebrile — full stop. Eval for Hemolytic Uremic Syndrome

Articles of Interest

There's a cheap and effective way to treat childhood diarrhea. So why is it underused?

"The problem is massive," he says. "Hundreds of thousands of kids die from diarrhea, when none of them should be dying. There's a treatment that's been around for decades that we know is really effective. When you ask doctors in surveys, what they would do for a hypothetical case of diarrhea, most of them say they would prescribe ORS. If that's the case, why wasn't it being used?

Dehydration and diarrhea in children: Prevention and treatment

An oral rehydration solution (ORS) is a mixture of water, salts and sugar in specific amounts. These solutions can be absorbed even when your child has large amounts of diarrhea or is vomiting.

Infectious Diarrhea

Fever and/or Bloody diarrhea should catch your attention for possible enteropathogens. Most children do NOT need empiric antibiotics for acute diarrhea. Stool Culture can be helpful, particularly in the setting of bloody diarrhea, but antibiotics can usually wait for results as many pathogens do not benefit from antibiotics.

Pediatric Diarrhea: History is the Primary Diagnostic Tool

A 2017 guideline published by the Infectious Disease Society of America for the diagnosis and management of diarrhea recommends testing for Salmonella, Shigella, Campylobacter, Yersinia, C. difficile, and STEC in people with diarrhea and fever, bloody or mucoid stools, severe abdominal cramping or tenderness, or signs of sepsis. They do not recommend empiric antibiotics in the setting of a presumed infectious diarrhea unless the patient is an infant less than 3 months of age with a suspected bacterial etiology, has a presumptive diagnosis of Shigella, or has recently travelled internationally and has a fever ≥38.5°F or signs of sepsis. If antibiotics are indicated, choose ceftriaxone as first line. Alternative agents include ciprofloxacin, ampicillin, amoxicillin, or TMP-SMX as alternatives.

The Management of Acute Diarrhea in Children: Oral Rehydration, Maintenance, and Nutritional Therapy

The use of nonspecific antidiarrheal agents such as adsorbents (e.g., kaolin-pectin), antimotility agents (e.g., loperamide), antisecretory drugs, or toxin binders (e.g., cholestyramine) is a common practice in many developed and developing countries. Despite the theoretical benefits from their use, available data do not demonstrate their effectiveness in reducing diarrhea volume or duration.