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Gastroenteritis in children: Part 1. Diagnosis
Catherine A Churgay1, Zahra Aftab
1Hope Medical Clinic, Ypsilanti, MI, USA.
Insights
Viral and bacterial gastroenteritis are common in children. Assessment focuses on dehydration using physical signs and history, with lab tests reserved for severe cases or persistent diarrhea.
Area of Science:
- Pediatrics
- Infectious Diseases
- Gastroenterology
Background:
- Acute gastroenteritis is a significant cause of childhood morbidity in the U.S.
- Viral pathogens, notably rotavirus, account for the majority of cases (75-90%).
- Bacterial infections, including diarrheagenic Escherichia coli (up to 10%), are also implicated.
Purpose of the Study:
- To outline the diagnostic approach for acute gastroenteritis in children.
- To emphasize the assessment of dehydration and determination of etiology.
- To guide the judicious use of laboratory testing.
Main Methods:
- Clinical history and physical examination are primary diagnostic tools.
- Key physical signs for dehydration include abnormal respiratory pattern, skin turgor, and capillary refill time.
- Retrospective evaluation of dehydration can utilize weight changes.
Main Results:
- Parental history is a valuable component of the assessment.
- Serum electrolyte levels are generally not required for mild to moderate dehydration.
- Laboratory tests and intravenous fluids are indicated for severe dehydration.
Conclusions:
- Stool cultures are not routinely necessary but should be considered for persistent diarrhea.
- Effective management hinges on accurate dehydration assessment and etiological diagnosis.
- This approach optimizes resource utilization in pediatric gastroenteritis care.
Abstract:
Acute gastroenteritis in children is a major cause of morbidity in the United States. Viral infections, primarily from rotavirus, cause 75 to 90 percent of cases. The remaining infections are largely bacterial, with as many as 10 percent of cases secondary to diarrheagenic Escherichia coli. The history and physical examination of children with gastroenteritis should focus on assessing for the presence and degree of dehydration and determining the underlying etiology. The child's weight during the illness versus posttreatment is often used to evaluate degree of dehydration retrospectively. The three examination signs that best suggest dehydration in children are an abnormal respiratory pattern, abnormal skin turgor, and prolonged capillary refill time, although parental report of the child's history is also helpful in the assessment. In general, measuring serum electrolyte levels usually is unnecessary in children with mild to moderate dehydration. Laboratory tests are recommended only when severe dehydration is suspected; in such cases, intravenous fluids would be warranted. Although it is not necessary to routinely obtain stool cultures, they should be collected if diarrhea is persistent.