Management of Acute Diarrhea in Emergency Room

Abstract

Acute diarrhea is the second leading cause of under-five mortality in India. It is defined as the passage of frequent watery stools (>3/24 h). Recent change in consistency of stools is more important than frequency. Acute diarrhea is caused by variety of viral, bacterial and parasitic agents. The common ones are: Rotavirus, E. coli, Shigella, Cholera, and Salmonella. Campylobacter jejuni, Giardia and E. histolytica are also not uncommon. The most important concern in management of acute diarrhea in Emergency room (ER) is fluid and electrolyte imbalances and treatment of underlying infection, wherever applicable. It includes, initial stabilization (identification and treatment of shock), assessment of hydration and rehydration therapy, recognition and treatment of electrolyte imbalance, and use of appropriate antimicrobials wherever indicated. For assessment of hydration clinical signs are generally reliable; however, in severely malnourished children sunken eyes and skin turgor are unreliable. Oral Rehydration Therapy is the cornerstone of management of dehydration. Intravenous fluids are not routinely recommended except in cases of persistent vomiting and/or shock. Majority of cases can be managed in ER and at home. Hospitalization is indicated in infants <3 mo, children with severe dehydration, severe malnutrition, toxic look, persistent vomiting and suspected surgical abdomen. Supplementations with zinc and probiotics have been shown to reduce severity and duration of diarrhea; however evidence does not support the use of antisecretary, antimotility and binding agents. Education of parents about hand hygiene, safe weaning and safe drinking water etc., can help in reducing incidence of this important health problem in the country.

This is a preview of subscription content, access via your institution.

Fig. 1
Fig. 2

References

  1. 1.

    WHO/UNICEF. Joint statement on clinical management of acute diarrhea. New York: UNICEF; 2004. [cited on 25-09-2011]. Available at: http://www.unicef.org/publications/index_21433.html.

    Google Scholar 

  2. 2.

    Department of Maternal, Child and Adolescent Health, World Health Organization. ‘Diarrhea treatment guidelines including new recommendations for the use of ORS and zinc supplementation for clinic-based healthcare Workers’. Arlington: USAID; 2005. [cited on 25-09-2011]. Available at: http://www.who.int/maternal_child_adolescent/documents/a85500/en/index.html.

    Google Scholar 

  3. 3.

    Bhutta ZA. Acute gastroenteritis in children. In: Kliegman S, St. Geme Schor B, eds. Nelson textbook of pediatrics. 19th ed. Philadelphia: Elsevier Saunders; 2011. pp. 1323–38.

    Chapter  Google Scholar 

  4. 4.

    Singhi S. Acute diarrhea. In: Singhi S, Surpure JS, eds. Synopsis of Pediatric Emergency Care. 2nd ed. Delhi: PEEPEE; 2010. pp. 341–7.

  5. 5.

    Haque R, Mondal D, Duggal P, et al. Entamoeba histolytica infection in children and protection from subsequent amebiasis. Infect Immun. 2006;74:904–9.

    PubMed  Article  CAS  Google Scholar 

  6. 6.

    Ajjampur SS, Sankaran P, Kannan A, et al. Giardia duodenalis assemblages associated with diarrhea in children in South India identified by PCR-RFLP. Am J Trop Med Hyg. 2009;80:16–9.

    Google Scholar 

  7. 7.

    Khan WA, Rogers KA, Karim MM, et al. Cryptosporidiosis among Bangladeshi children with diarrhea: a prospective matched case–control study of clinical features, epidemiology and systemic antibody responses. Am J Trop Med Hyg. 2004;71:412–9.

    PubMed  Google Scholar 

  8. 8.

    CDC Disasters. Guidelines for the management of acute diarrhea after a disaster. Atlanta: Centers for Disease Control and Prevention; 2008. [cited on 25-09-2011]. Available at: http://emergency.cdc.gov/disasters/disease/diarrheaguidelines.asp.

    Google Scholar 

  9. 9.

    World Gastroenterology Organization (WGO). WGO practice guideline: Acute diarrhea. Munich: World Gastroenterology Organization (WGO); 2008. p. 28. [cited on 25-09-2011]. Available at: http://www.dphhs.mt.gov/publichealth/cdepi/documents/WorldGastroenterologyOrganizationPracticeGuideline.pdf.

    Google Scholar 

  10. 10.

    Bhatnagar S, Lodha R, Choudhury P, et al. IAP Guidelines 2006 on management of acute diarrhea. Indian Pediatr. 2007;44:380–9.

    PubMed  Google Scholar 

  11. 11.

    Allen SJ, Martinez EG, Gregorio GV, Dans LF. Probiotics for treating acute infectious diarrhoea. Cochrane Database Syst Rev. 2010;11:CD003048. doi:10.1002/14651858.CD003048.pub3.

    PubMed  Google Scholar 

  12. 12.

    Szajewska H, Mrukowicz JZ. Probiotics in the treatment and prevention of acute infectious diarrhea in infants and children: a systematic review of published randomized, double-blind, placebo-controlled trials. J Pediatr Gastroenterol Nutr. 2001;33:S17–25.

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Sachdev HP, Kumar S, Singh KK, Satyanarayana L, Puri RK. Risk factors for fatal diarrhea in hospitalized children in India. J Pediatr Gastroenterol Nutr. 1991;12:76–81.

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Uysal G, Sökmen A, Vidinlisan S. Clinical risk factors for fatal diarrhea in hospitalized children. Indian J Pediatr. 2000;67:329–33.

    PubMed  Article  CAS  Google Scholar 

Download references

Conflict of Interest

None.

Role of Funding Source

None.

Author information

Affiliations

Authors

Corresponding author

Correspondence to Sunit C. Singhi.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Dekate, P., Jayashree, M. & Singhi, S.C. Management of Acute Diarrhea in Emergency Room. Indian J Pediatr 80, 235–246 (2013). https://doi.org/10.1007/s12098-012-0909-3

Download citation

Keywords

  • Children
  • Acute diarrhea
  • Oral rehydration therapy
  • Severe dehydration