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Acute gastroenteritis is defined as diarrheal disease of rapid onset, often with nausea, vomiting, fever, or abdominal pain. It occurs an average of 1.3-2.3 times per year between the ages of 0 and 5 years diarrhea, salmonella, rotavirus, shigella, gastroenteritis, ecoli, e coli. Rates among children in child care centers are

Viral Gastroenteritis

All of the viruses produce watery diarrhea often accompanied by vomiting and fever, usually not associated with blood or leukocytes in the stool or with

Rotavirus is the predominant viral cause of dehydrating diarrhea. Rotaviral infections tend to produce severe diarrhea, causing up to 70% of episodes in children under 2 years of age who require hospitalization. Rotavirus infection tends to occur in the fall in the southwest of the US, then sweeping progressively

Norwalk viruses are the major cause of large epidemics of acute nonbacterial gastroenteritis. In schools, camps, nursing homes, cruise ships, and restaurants.

Enteric adenovirus is the third most common organism isolated in infantile diarrhea.

Bacterial Gastroenteritis

The bacterial diarrheas work through the elaboration of toxin (enterotoxigenic pathogens) or through invasion and inflammation of the

Secretory diarrheas are modulated through an enterotoxin, and the patient does not have systemic symptoms (fever, myalgias) or signs of local irritation of the bowel (tenesmus), or evidence of gut inflammation in the stool (white or red blood cells). The diarrhea is watery, often is large in volume, and often associated with nausea and

Invasive diarrhea is caused by bacterial enteropathogens, and is accompanied by systemic signs, such as fever, myalgias, arthralgias, irritability, and loss of appetite. Cramps and abdominal pain are prominent. The diarrhea consists of the frequent passing of small amounts of "mucousy" stool. Stool examination reveals leukocytes, red blood cells, and often

The same organisms that typically cause an invasive or inflammatory pattern of illness also may cause a secretory or 

Acute Diarrhea Patterns and Associated Pathogens



Characterized by watery diarrhea and absence of fecal leukocytes

Characterized by dysentery (ie, symptoms and bloody stools), fecal leukocytes, and erythrocytes

Food poisoning (toxigenic)

Staphylococcus aureus

Bacillus cereus

Clostridium perfringens


Invasive E coli




Escherichia coli

Vibrio cholera

Giardia lamblia



Norwalk-like virus

C difficile

Entameba histolytica

Clinical Evaluation and Treatment of Acute Diarrhea

Step One--Assess child for degree of dehydration

No dehydration

Continue oral hydration and feeding

Some/severe dehydration--------->

Initiate rehydration by oral route (intravenous for severely dehydrated patients)

Step Two--Assess Clinical History for Etiologic Clues

Etiologic Clue

Etiology Suggested

Fever, crampy abdominal pain, tenesmus

Inflammatory colitis or ileitis

History of bloody stool

Shigella, enteroinvasive EC, amebiasis, other bacterial causes

Fever and abdominal pain and like appendicitis

Yersinia enterocolitis

Current or previous antibiotic use

Antibiotic-associated enteritis or pseudomembranous colitis

Multiple cases and common food source

Incubation <6 hours: Staphylococcus aureus, Bacillus cereus

Incubation >6 hours: Clostridium perfringens

Ingestion of inadequately cooked seafood

Vibrio sp

Recent measles, severe malnutrition, AIDS, other causes of immunosuppression

Bacterial (Salmonella), viral (rotavirus), or parasitic (isosporiasis, Cryptosporidium)

Step Three--Examine Stool:

Indicated for:


Etiology Suggested:

Visual examination of specimen

All patients

Gross blood

Dysentery, colitis, invasive organism


examination for

white/red blood cells

Patients who have had diarrhea >3 days, fever, blood in stool, weight loss beyond fluid deficit

Red cells and leukocytes

Red cells without leukocytes

Shigella, enterohemorrhagic EC, enteroinvasive EC, Campylobacter, Clostridium, E histolytica

Parasitic examination (wet mount, acid-fast staining, or concentration)

Diarrhea >10 days


Giardia, Amoeba, Cryptosporidium, Isospora, Strongyloides

Clostridium difficile toxin

Especially patients taking antibiotics


C difficile colitis

Fluid Therapy

Mild-to-moderate dehydration

Oral rehydration therapy (ORT) is the preferred method. ORT is a glucose-electrolyte solution.

Mildly or moderately dehydrated children should receive ORT at 50 mL/kg (mild dehydration) or 100 mL/kg (moderate dehydration) over a 4-hour period. Replacement of stool losses (at 10 mL/kg for each stool) and of emesis (estimated volume) will require adding appropriate amounts of solution to the total.

If all but sips of fluid are vomited, oral hydration can be achieved by administering a


Clinical Evaluation and Treatment of Persistent Diarrhea-lasting longer than 14 Days


Assess child for degree of dehydration ------------> Appropriate rehydration

Step–Two. Assess Etiologic Clues

Etiologic Clue

Etiology Suggested

Bloody stool

Invasive organism, particularly Shigella and Entameba histolytica

Malnutrition (inadequate weight for age)

Inadequate diet, decreased resistance

Dietary changes, especially addition of milk or formula

Possible milk or protein hypersensitivity

Problems following milk ingestion

Lactose malabsorption

Antibiotic treatment

Antibiotic-associated enterocolitis or resistant organism

Step–Three. Stool Examination



Etiology Suggested

Visual examination

Bloody stool

Invasive organism

Microscopic stool exam, including search for ova, parasites, and Cryptosporidium

Red and white blood cells

E histolytica cysts

Giardia, E histolytica trophozoites

Shigella, other invasive organism

Etiologic role unclear

Etiologic role more likely; specific treatment indicated

Stool pH, reducing substances

pH <5.5 and ++ reducing substances

Lactose or other carbohydrate malabsorption.

Stool culture and sensitivity

Pathogens present

Etiology and antibiotic treatment