Now displaying: July, 2020
Jul 1, 2020
Traditional Approach:
Secretory -- poisoned mucosal villi -- "the sieve"
Cytotoxic -- destroyed mucosal villi -- "the shred"
Osmotic -- malabsorption -- "the pull"
Inflammatory -- edema, motility -- "the push"
Lots of overlap, difficult to apply to clinical signs and symptoms.
Bedside Approach:
Fever/No Fever, Bloody/No Blood
Non-bloody, febrile -- most likely viral
Non-bloody, afebrile -- may be viral
Bloody, febrile -- likely bacterial
Non-bloody, afebrile -- full stop. Eval for Hemolytic Uremic Syndrome
Workup
Ask yourself -- again -- why is this not... appendicitis-torsion-intussusception-etc.
Admit sick children, but most go home, so...
Non-bloody, febrile -- no workup necessary; precautionary advice
Non-bloody, afebrile -- be more skeptical, but generally same as above
Bloody, febrile -- stool culture, follow up; do not treat empirically unless septic and admitted. Culture will dictate treat/no treat/how.
Bloody, afebrile -- evaluate for hemolytic uremic syndrome, especially if under 5 years old: CBC, chemistries, UA, stool culture
Evaluate Hydration Status
Selected References
Khan WA et al. Central Nervous System Manifestations of Childhood Shigellosis: Prevalence, Risk Factors, and Outcome. Pediatrics. 1999 Feb;103(2):E18
Lee JY et al. Diagnostic yield of stool culture and predictive factors for positive culture in patients with diarrheal illness. Medicine (Baltimore). 2017 Jul; 96(30): e7641.
Nelson JD et al. Treatment of Salmonella gastroenteritis with ampicillin, amoxicillin, or placebo. Pediatrics 1980; 65:1125.
©2016 Tim Horeczko