Diarrhea: Is derived from Greek word, meaning

(following through), it is the second leading cause of

death in children under five years of age.
Definition:
*** The normal frequency and consistency of bowel
movements varies with child’s age and diet and
definition of diarrhea varies accordingly.
According to WHO, diarrhea is defined as passage of
three or more loose stool per day, or passing more
stools than normal for age.
More exact definition: is excessive daily stool liquid
volume (>10 ml stool /kg body weight/day).
Causes
Infectious diarrhea
 Antibiotic Associated diarrhea
Antibiotic-associated diarrhea is defined as 3 or
more loose stools within a 24-hour period after
antibiotic administration, which might occur within
hours or up to 8 weeks following commencement of
antibiotic use.
Elements associated with AAD include the age of
the child and the antibiotic agent used, among other
factors, with an estimated incidence of 5% to 30% in
children according to a review of 10 studies with 1438
children from 6 different countries.
Cephalosporins, clindamycin, and broad-spectrum
penicillins have been associated with a higher risk of AAD.
 Antibiotic Induced Diarrhea
Antibiotic-induced Diarrhea caused by the bacterium
Clostridium difficile (C. difficile), one of the most common causes
of infection of the large bowel (colon).
Patients taking antibiotics are at particular risk of becoming
infected with C. difficile. Antibiotics disrupt the normal bacteria
of the bowel, allowing C. difficile and other bacteria to become
established and overgrow inside the colon.
In some people, a toxin produced by C. difficile causes diarrhea
, abdominal pain, severe inflammation of the colon (colitis), fever
an elevated white blood cell count, vomiting, and dehydration.
In severely affected patients, the inner lining of the colon
becomes severely inflamed (pseudomembranous colitis). Rarely,
may leads to colon perforation, which can lead to a life-
threatening infection of the abdomen.
History
The goal of the history and physical examination is to
determine the severity and etiology of the child's
condition. Accurate classification of the degree of
dehydration as mild, moderate, or severe allows for
appropriate therapy and disposition of the patient in a
timely fashion.
Obtaining a complete history from the parent or
caregiver is important because it provides clues to the
type of dehydration present.
Concentrate on following points:
• Feeding pattern and fluids given
• Fluid loss (eg, vomiting, diarrhea)
• Number of wet diapers compared with normal,
suggesting oliguria or anuria
• Activity level
• Possible ingestions that may cause vomiting
• Heat and sunlight exposures for insensible losses
• Current illness pattern, fever, ill contacts
• Recent weight prior to current illness (infants
typically have regular well child appointments with
weight recorded)
• Physical Examination
• The severity of dehydration is typically measured as
the acute weight loss (presumably fluid) as a
percentage of pre-illness weight. However, the pre-
illness weight is often not available in the ED setting
and clinicians have to rely on the patient’s history
and physical examination findings to assess the
severity of dehydration.
• for recognizing 5% dehydration are the following
• Abnormal capillary refill time
• Abnormal skin turgor
• Abnormal respiratory pattern
Differential Diagnoses
• Diabetic Ketoacidosis (DKA)
• Hypernatremia
• Hyperosmolar Hyperglycemic Non-ketotic Coma
• Hypokalemia
• Hyponatremia
• Hypovolemic Shock
• Metabolic Acidosis
• Pyloric Stenosis
 Treatment
According to WHO
Depends on degree
of dehydration.
In general
1- fluid for
rehydration
2- Zinc
3- other