Acute and Chronic Diarrhea in Children (Nursing)

00:01 So we're gonna kind of dive into some of those causes of dehydration.

00:06 And one of the big causes of dehydration in pediatric patients is diarrhea.

00:12 We know that pediatric patients have a tendency to pick up all those minor illnesses when they're young, still kind of getting that immune response up and running.

00:25 So pediatric patients catch all of the viruses and stuff that are floating around out in the community.

00:31 And a lot of those will cause diarrhea.

00:33 So there's two main types of diarrhea.

00:36 We have acute diarrhea, and then you can also have chronic diarrhea.

00:43 So there are some common causes of acute diarrhea.

00:48 And we will talk about this list, but the most important thing to know is that if you have acute diarrhea, that's less than 14 days.

00:57 So if you have a pediatric patient that has had diarrhea on and off for a day or two, that's very acute, but all the way up until 14 days is still considered acute.

01:07 And what are some things that might cause this? Well, there's actually medications that can cause diarrhea.

01:12 So antibiotics, if you have a patient that had pneumonia, got put on some antibiotics.

01:17 Next thing you know, they have some diarrhea.

01:21 Patients in the hospital often are getting magnesium supplementation that can cause diarrhea.

01:27 Chemotherapy, antacids, strangely enough can also cause diarrhea.

01:32 So it's important to know that some medications can cause this.

01:36 And usually when you stop the medication, the diarrhea will also stop.

01:39 Infections, like we said, can also cause diarrhea.

01:43 Norovirus and rotavirus being two of the big culprits when we're thinking about reasons that pediatric patients might have diarrhea, and then you can see Salmonella, E. Coli.

01:56 So you don't have to memorize this list, but just knowing that some of the stomach infections can cause this as well.

02:02 So just to kind of keep along with this clinical example, when you have a gastroenteritis, meaning you have an infection of your stomach.

02:13 It can be caused by a virus or bacteria.

02:16 For this example, we use rotavirus.

02:19 For rotavirus can cause you to have three or more loose stools in a day.

02:26 And so that's definitely going to cause some dehydration.

02:29 But rotavirus is pretty self limited, and it's usually not going to last more than 14 days, which is why this is considered a more acute condition.

02:39 So this fluid loss can range from anywhere from 5 milligrams per kilo per day.

02:47 And notice that we think of everything in terms of weight for pediatric patients.

02:52 Because if I just told you, a pediatric patient lost 50 milliliters of fluid, that might not sound like a lot, but if I tell you, your patient is only five kilograms, 50 milliliters, all of the sudden sounds a little bit more.

03:06 So think about pediatric patients in terms of weight.

03:10 So 5 milliliters per kilo per day, all the way up to more than 200 milliliters per kilo per day.

03:18 So that kind of brings to focus the fact that for dehydration, there's different levels.

03:24 You can have mild dehydration, moderate dehydration, all the way up to severe dehydration.

03:30 And those are going to present a little bit differently.

03:34 Continuing with our rotavirus example, this actually does cause pretty severe diarrhea.

03:41 So you may see a pretty severe dehydration, if your patient has rotavirus.

03:46 And it's highly contagious.

03:48 So if you have one kiddo in a daycare that has rotavirus, they're all going to have rotavirus.

03:54 Along with their caregivers and pretty much everybody's going to be miserable.

03:58 So, hand washing definitely is the key.

04:01 Rotaviruses also cause fever and vomiting.

04:06 So not only do you have this acute diarrhea that is causing fluid loss, you also have had fever and vomiting, which we mentioned at the beginning of the presentation are two other causes of fluid loss in children.

04:19 So they are just getting attacked from all points here.

04:23 The symptoms you usually appear about two days after exposure, which is one of the reasons why this will roll through a daycare in certain situations.

04:31 Because these kiddos don't know that they have it.

04:34 They're rolling around and passing it along to all their friends.

04:38 Next thing you know, everybody's got vomiting and diarrhea.

04:42 It's fun times.

04:43 So vomiting and watery diarrhea that lasts from about 3 to 8 days are a hallmark of rotavirus.

04:50 So as you can see, this particular cause of diarrhea less than 14 days, but can cause a pretty severe dehydration.

05:01 So, there are definitely some indications for evaluation of acute diarrhea.

05:06 Not every child that gets a little bit of diarrhea is going to come into the hospital or the urgent care.

05:11 But sometimes they should be seen by a provider.

05:15 Those pediatric patients that are less than six months of age or if they were preterm at birth or have chronic conditions, if they have diarrhea, they should probably be evaluated.

05:27 Some additional reasons for evaluating a pediatric patient that has diarrhea that's fairly short lived the acute, remember less than 14 days.

05:36 So it's fairly short lived.

05:39 If the patient's having fever, if they are having frequent or substantial volume of diarrhea, that would be another reason for them to be evaluated by a provider.

05:52 If they are having any changes in mental status, then we are way into the realm of severe dehydration.

06:00 And that patient should be evaluated because they are becoming very, very sick.

06:06 Lack of response to oral replacement therapy would also be another reason to come into the hospital and be evaluated for the diarrhea.

06:16 If the parent is at home, and the child is having diarrhea, and they can keep up with that, with oral replacement therapy, meaning they're giving them small amounts of fluid over a period of time and we will go into oral replacement therapy in another presentation, then they may be fine staying at home.

06:35 But if any of these other things happen, they really should be seen.

06:40 So I mentioned that there were two types of diarrhea and we've talked about acute diarrhea.

06:45 The second type is chronic.

06:47 So one of the things that is important to know is that chronic diarrhea is diarrhea that happens for more than 14 days.

06:56 And sometimes patients have diarrhea for months or years.

07:01 So it's important to know that you don't need to remember all the causes of the chronic diarrhea, but just a little bit of contrast for the types of things that cause acute diarrhea, Chronic diarrhea is more things like celiac disease, maybe IBS, food allergies and intolerance, small intestinal bacterial overgrowth can sometimes cause some chronic diarrhea.

07:26 So these are things that are need to be managed over time, and can cause that diarrhea to be a problem for longer periods of time.

07:36 And that's really the big difference between the acute diarrhea and the chronic diarrhea.