Pediatric emergency medicine trisk 0531 0531
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CHAPTER 23 ■ DIARRHEA
FARIA PEREIRA, DEBORAH C. HSU
INTRODUCTION
Diarrhea, defined as a decrease in the consistency of the stool (loose/watery)
and/or greater than three stools in a 24-hour period, is a common presenting
complaint to the emergency department (ED). Infants and children have
variability in frequency and type of stools; therefore, any deviation from the usual
stooling pattern should arouse at least a mild concern, regardless of the actual
number of stools or their water content. An acute diarrheal illness typically lasts
less than 7 days. In the United States, diarrhea accounts for approximately 1.7
million annual outpatient visits. Although most bouts of illness are self-limited,
approximately 70,000 patients are hospitalized each year. Since the introduction
of the rotavirus vaccine in 2006, the number of children hospitalized due to
diarrheal disease has decreased significantly.
DIFFERENTIAL DIAGNOSIS
Diarrhea may be the initial manifestation of a wide spectrum of disorders as
outlined in Table 23.1 . The most common etiology for diarrhea in pediatric
patients presenting to the ED is viral gastroenteritis, with norovirus and rotavirus
being the most common agents. Other causes include bacterial and parasitic
infections, parenteral diarrhea (nongastrointestinal infection such as otitis media),
and antibiotic induced. The emergency physician must be vigilant in recognizing
the few children who have diseases that are likely to be life threatening from
among the majority of children who have self-limiting infections. Particularly
urgent
are
intussusception,
hemolytic
uremic
syndrome
(HUS),
pseudomembranous colitis, and appendicitis ( Table 23.2 ). In addition, children
may develop severe dehydration with diarrhea secondary to any etiology.
Intussusception is a potentially life-threatening condition that can present with
bloody diarrhea, although this is not the typical presenting complaint.
Intussusception peaks in frequency between 5 and 10 months of age and tapers
off rapidly after 2 years of age unless there is a predisposing pathologic condition.
This topic is covered in more detail in Chapter 53 Pain: Abdomen .
HUS should also be considered in a child presenting with bloody diarrhea.
HUS is an uncommon but potentially life-threatening disease that typically
presents with the classic triad of microangiopathic hemolytic anemia,
