UMEM Educational Pearls

Title: Diarrhea in Children- A Major Global Killer (part 1)

Keywords: Diarrhea, infectious diseases, pediatrics, global health (PubMed Search)

Posted: 5/20/2015 by Jon Mark Hirshon, PhD, MPH, MD
Click here to contact Jon Mark Hirshon, PhD, MPH, MD

Background:

While diarrhea in adults can be inconvenient and briefly debilitating, in children it can be fatal. Globally, diarrheal diseases are the second leading cause of death for children under five.

Approximately 760,000 children under five die each year from diarrhea
- Kills 2,200 children daily- more than AIDS, malaria and measles combined
Most of the diarrhea can be prevented
- Safe drinking water
- Adequate sanitation and hygiene
Diarrhea is also a leading cause of malnutrition

Clinical types of Diarrhea (with common infectious causes):

Acute watery diarrhea lasting hours or days (e.g. rotavirus, norovirus, Vibrio cholerae)
Acute bloody diarrhea, a.k.a. dysentery (e.g. Entamoeba histolytica, Shigella, Salmonella, Campylobacter, E. coli)
Persistent diarrhea lasting longer than 14 days (e.g. parasites, C. difficile)

Clinical assessment:

Early dehydration- no signs or symptoms
Moderate dehydration
- Thirst
- Irritability/tiredness/lightheadedness
- Dry mucous membranes/decreased tears
- Decreased urine output/dark (concentrated) urine
- Sunken eyes
- Decreased capillary refill (2-4 sec)*
- Decreased skin turgor*
- Increased respiratory rate*
Severe dehydration
- Decreased mental status
- Shock (rapid heart rate, low blood pressure)
- Minimal or no urine output
- Very sunken eyes/no tears
- Parched/cracked mucous membranes
- Marked decreased capillary refill (> 4 sec)*
- Skin tenting*
- Markedly increased respiratory rate*

*Best indicators of hydration status

Next week: Prevention and Treatment

References

http://www.who.int/mediacentre/factsheets/fs330/en/

http://www.cdc.gov/healthywater/global/diarrhea-burden.html

http://emedicine.medscape.com/article/906999-clinical#a0217