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Family Medicine Diplomate Exam > Diarrhea, pediatric > Flashcards

Diarrhea, pediatric Flashcards

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1
Q

What is the definition of acute diarrhea?

A

A: passage of 3 or more loose, watery, or bloody stools from an immunocompetent person’s normal baseline in a 24-hour period lasting < 14 days.

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2
Q

What are the key symptoms that may accompany acute infectious diarrhea?

A

A: Nausea, vomiting, abdominal pain and fever

Acute infectious diarrhea - suspected if a patient present with passage of 3 or more loose, watery or bloody stools within 24 hours

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3
Q

What should be included in the pre-treatment clinical evaluation for acute infectious diarrhea?

A

A: Extensive clinical history, including consumption of raw, ill-prepared, or rotten food, and intake of contaminated food or water, and a complete physical examination to assess severity, dehydration, complications, and comorbid conditions.

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4
Q

When are stool cultures indicated in cases of acute infectious diarrhea?

A

A: Severe cases, high risk for transmission, increased risk of complications, for epidemiologic purposes, and suspicion of an outbreak.

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5
Q

What are the clinical parameters indicating dehydration in children with acute infectious diarrhea?

A

A: Vital signs (tachycardia, tachypnea), level of consciousness, depressed fontanel, sunken eyeballs, presence of tears, skin turgor, capillary refill time, abnormal respiratory pattern, and history of urine output.

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6
Q

What is the recommended management for dehydration in children with acute infectious diarrhea?

A

A: Continue breastfeeding, avoid sports, carbonated, caffeinated, and sweetened drinks, and use ORS for rehydration.

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7
Q

What are the indications for empiric antibiotic treatment in children with acute infectious diarrhea?

A

A: Suspected or confirmed cholera, shigella, and amoebiasis.

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8
Q

What non-specific medications may be given to children with acute infectious diarrhea?

A

A: Zinc supplementation, racecadotril, and probiotics.

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9
Q

What is the recommended management for dehydration in adults with acute infectious diarrhea?

A

A: Oral rehydration solution for mild dehydration, IV fluids for moderate to severe dehydration, and monitoring of vital signs, mental status, peripheral perfusion, and urine output.

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10
Q

What are the indications for empiric antimicrobial treatment in adults with acute infectious diarrhea?

A

A: Suspected or confirmed cholera, shigella, non-typhoidal salmonella dysentery, and amoebiasis

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11
Q

What are the recommended prevention measures for acute infectious diarrhea?

A

A: Hand hygiene, clean and safe drinking water, proper food handling, proper excreta disposal, vaccination, and breastfeeding.

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12
Q

What is the role of probiotics in the management of acute infectious diarrhea in children?

A

A: Probiotics are recommended as adjunct therapy to reduce symptom severity and duration of diarrhea.

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13
Q

What is the role of anti-emetics in the management of vomiting in children with acute infectious diarrhea?

A

A: Anti-emetics are not recommended due to safety issues.

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14
Q

What is the recommended diet for children with acute infectious diarrhea?

A

A: Continue breastfeeding, resume age-appropriate usual diet during or immediately after rehydration, and consider lactose-free diet if diarrhea persists for more than 7 days.

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15
Q

What are the recommended interventions for preventing acute infectious diarrhea?

A

A: Hand hygiene, safe drinking water, proper food handling, proper excreta disposal, vaccination, and breastfeeding.

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16
Q

What are the signs of severe dehydration in children?

A

LOC: Lethargy or unconsciousness
Eyes: sunken eyes, no tears
Mouth: can’t drink
Skin: capillary refill >3 seconds
RR: deep and rapid respiration
UO: little or no urine output.

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17
Q

What are the signs of severe dehydration in adults?

A

A: Shock, respiratory rate ≥25 breaths per minute, faint or thready heart rate, cold, clammy skin, coma/stupor, dry oral mucosa, severe muscle weakness, and capillary refill >2 seconds.

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18
Q

What is the role of colonoscopy in the evaluation of acute infectious gastroenteritis? A:

A

Colonoscopy is not warranted in the initial evaluation of acute infectious diarrhea.

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19
Q

What are the complications of acute infectious diarrhea?

A

A: Acute kidney injury and electrolyte imbalances.

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20
Q

is routine stool exam indicated in most cases of acute watery diarrhea?

A

ONLY if parasitism is suspected or in the presence of bloody diarrhea

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21
Q

Are biomarkers like CRP, calprotectin, ESR, PCT, total serum WBC indicated?

A

NO sufficient evidence

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22
Q

is rapid diagnostic test recommended during suspected outbreaks of diarhea and shigella>

A

Yes but confirmation with stool culture is recommended

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23
Q

parameters of no signs of dehyration

A

well, alert
drinksnormally not thirsty
fontanels or eyes are normal
tears are present
capillary refill is < 2 sec
Respiration is normal
skin pinch goes back quickly
urine out put is normal

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24
Q

parameters of some signs of dehydration

A

restless, irritable
thirsty, drinks eagerly
slightly depressed or sunken fontanel or eyes
tears are present or decreased
capillary refill around 2 seconds
respiration is deep but may be rapid
skin pinch goes back slowly
urine output is decreased < 0.5 ml/kg/hr x 8 hours

if with 2 or more, there is mild to moderate dehydration

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25
parameters for severe dehydration
Lethargic or LOC Skin: skin pinch goes back very slowly Head: fontanels or eyes are sunken no tears Mouth: drinks poorly or not able to drink Lungs: respiration is deep and rapid 2mos - 12 mos = 50 or more; 12 mos-5 yo 40 or more Kidney: UO <0.3ml/kg/hr in 16 hours or none in 12 hours (2 or more, severe)
26
Clinical manifestations in MILD dehydration in adult
Level of consciousness: Alert VS: BP and RR Normal HR is 80 or mo Skin: mucosa is moist peripheral is warm to touch < 2 sec skin sturgor and capillary refill Mouth: thirst +/- UO is 0.5 ml/kg/hr or more 3-5% dec in weight within 7 days or less or inc 3-5% within 7 days as an indication for hydration
27
clinical manifestations in MODERATE dehydration in adult
LOC: lethargic VS: orthostatic hypotension RR of 21-25 HR > 100 Skin: Dry Mucosa Cold clammy skin Skin turgor and capillary refill is > 2 secs Eyes: sunken eyes + Mouth: Thirsty Strength: fatigue; muscle weakness is mild to moderate UO: < 0.5 ml/kg/hr
28
clinical manifestation of SEVERE dehydration in adults
LOC: coma/stupor VS: BP is in shock RR > 25 HR: thready or faint Skin: Dry mucosa Cold clammy skin Skin turgor and capillary refill are > 2 secs sunken eye balls Strength: fatigue; severe weakness/ muscle wasting UO is < 0.5 ml/kg/hr
29
lab test to assess presence of complications in acute infectious diarrhea
AKF or electrolyte imbalance in both adult and pedia - CBC, UA, NA, K, CL, BUN.Crea, serum HCO3 or total CO2
30
Who should be admitted among children with acute infecitous diarrhea
Unable to tolerate fluids Suspeted electrolyte abnormalities Physical Exam: Respiratory Distress Hypothermia <36 Altered LOC ( MNEMONIC: batang nakahiga, hindi alerto, naka hook s aoxygen, may droplight and dede ay puno pa) Conditions for safe follow-up and home management are not met
31
Management for no dehydration in children
reduced oral rehydration
32
management for mild-mod dehydrationchildren
reduced osmolarity ORS via mouth or NGT if not feasible
33
management for severe dehydration in children
rpid iv with LR or 0.9 NaCl with or without 5% glucose
34
If there are no signs of DHN, what should be done
1. Continue age appropriate diet 2. Provide fluid as tolerated 3. Replace ongoing losses with ORS: < 2 yrs old: 50 - 100 ml ORS after each loose stool 2-10 yrs old: 100 ml ORS after each loose stool >10 yrs old: as much fluid as they want
35
If mild to moderate DHN, how to replace ORS
approximate amount given in 4 hours (weight (kg) x 75 ml) PLUS 2 yrs old: 50 - 100 ml ORS after each loose stool 2-10 yrs old: 100 ml ORS after each loose stool >10 yrs old: as much fluid as they want
36
If ORS is not tolerated , what should be done
ORS thru NGT or LRS or PNSS (with or without 5% glucose) at 75 ml/kg in 4 hours IV
37
In severe dehydration adult or children,what should be done
< 12 years old, give 30 ml/kg of LRS or PNSS in 1 hours then given 70 ml/kg in 5 hours Older, 30 ml/kg in 30 minutes then 70 ml/kg in 2 1/2 hours re assess hydration every 15=30 mins then every hours. if with still severe dehydration, repeat
38
in a patient with severe dehydration, hydration was succesful, what should be done next?
either ORS if tolerated or D50.45% NaCl at maintenance rate
39
what is the maintenance rate of IVF
Daily water requirement of 1500 ml/m2 BSA/day or Holliday segar
40
how to compute for holiday segar?
in 24 hours 0-10 kg = 100 ml/kg 10-20 kg = 1000 ml + 50ml/kg in excess of >10 kg >20 kg = 1500 ml + 20 ml/kg in excess of 20kg PLUS on going losses in 24 hours once urinating add 20meq KCL/L of IVF
41
What is the recommended antimicrobials for suspected or confirmed cholera in children
azithromycin 10 mg/kg/dose OD x3 days or 20 mg/kg x 1 dose (max 500 mg/24 hrs) Doxycycline 300 mg single dose (for >8 yo: 2mg/kg max100 mg) Alternate: Cotri 10 mg/kg/day of timethoprim and 50 mg/kg/day of sulfamethoxazole BID x 5 days (max 160 mg/dose BID) Chloramphenical 50-100 mg/kg/day QID for 3 days max 750 mg Erythromycin 12.5 mg/kg/dose QID x 3 days (max 4g/24 hrs)
42
Antimicrobial for suspected or culture-proven shigella in children
ceftriaxone IV 50-75 mg/kg/d every 12-24 hrs (max 2g/24 hrs) for 2-5 days cipro 30 mg/kg/d divided into 2 doses x 3 days max IV 500 mg/24 hrs Azithromycin 10 mg once a day for 3 days
43
Antimicrobial for non-typhoidal Salmonella in chidlren
Antibiotic treatment is NOT recommended for children with non-typhoidal Salmonella except in high risk children with certain underlying conditions to prevent secondary bacteremia including neonate or young infants <3 mos) immunodefiecient antomical or functional asplenia corticosteroid or immunosuppresive therapy, IBD or achlorhydria
44
Antimicrobial for Amoebiasis in children
Metronidazole 10mg/kg/dose TID (max dose 750 mg/dose)
45
NON-specific medications maybe given in children with infectious gastroenteritis
Zinc supplment 20 mg/day x 10-14 days in children >6 months - routine but not in < 6 mos Racecadotril 1.5mg/kg/dose) TID during the first 3 days of watery diarrhea Loperamide is NOT recommended for children
46
Role of anti-emetics in the management of vomiting in children
Anti-emetics are not recommended in children presenting with vomiting with AGE, infectious
47
Role of Probitiocis in the managment of acute infectious diarrhea in children
Probiotics may be extended for 7 more days after completion of antibiotics Saccharomyces boulardii Lactobacillus rhamnosus Lactobasillys reuteri BUT NOT Bacillus Clausii (erceflora)
48
Diet recommended for children with acute infectious diarrhea
Breasfeeding Age-appropriate usual diet if diarrhea persists for more than 7 days, LACTOSE FREE DIET Diluted lactose milk is not recommended
49
In adults, who should be admitted?
Poor tolerance to ors moderate to severe dehydration AKI and or electrolyte abnormalities Unstable comorbid condition Frail, elderly and/or with poor nutritional statuts unique social circumstances
50
Recommended management for adult with MILD dehydration
ORS 1.5 - 2x the amount of volume deficit plus concurrent GI losses
51
Recommended management for adults with moderate dehydration
500-1L PLR IV in first 2 hours. once stable 2-4 ml/kg/hr PLRS if < 50 kg and 1.5-2/kg/hr if > 50 kg. For Obese, use ideal bodyweight. NOTE; boluses vol/vol is recommended for moderate
52
Recommended management for adult with severe dhn
1 to 2L within first hour. once stable, same as moderate dhn
53
What IVF is recommended
PLRS (chloride-restrictive IVF) or PNSS if former is not available routine use of albumin, HES or dextran and gelatins not recommended
54
What are the indicators for aggressive fluid resuscitation
sBP < 100 mmHg HR > 100 bpm Capillary refill > 2 s or peripheries cold to touch RR > 20 cpm
55
What are the indications for empiric antimicrobial in adults with acute infectious diarrhea
mod to severe dehydration with any of the following: Fever alone, fever and Bloody stool either persisting for > 3dqays
56
What are the recommended antimicrobials for empiric treatment of acute infectious diarrhea
Azithromycin 1g single dose Cipro 500 BID x 3-5 days
57
antimicrobials for suspected or confirmed cholera
azithro 1 g OD x 5 days Cirpro 1-2 g single dose or 500 mg BID x 3 dayss Alt: doxycycline 100 mg BID x 3 days
58
Antimicrobial for suspected or culture-proven shigella
Ceftriaxone 1 g OD x 5 days Cipro 500 mg BID x 5 days Azithromycin 1 g single dose
59
Antimicrobial for suspected or confirmed non-typhoidal salmonella dysentery in adults
Cipro 500 mg BID x 5 days Ceftriaxone 1 g IV OD x 5 days
60
Antimicrobial for confirmed amoebiasis in adults
Metronidazole 500 - 750 mg tab TID x 10 days alt Tinidazole 2 g OD x 3 days Secnidazole 2 single dose diloxanide furoate 500 mg tab TID maybe added to metronidazole if available
61
What non-specific medications may be given in adults with acute infectious diarrhea
Loperamide is NOT recommended in adults with acute infectious diarrhea RACECADOTRIL 100 mg TID PROBIOTICS have insufficient evidence
62
Supplements
probiotics same as children Zinc supplementation for 6 months to 12 years old Vitamin A to 6 months and above 100,000 every 4-6 months 6-12 months 200,000 IU every 4-6 months for >12 years old Rotavirus vaccine is recommended to infants

Family Medicine Diplomate Exam (5 decks)

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