ACUTE DIARRHEA

Definition
- Sudden onset of excessively loose stools of >10mL/kg/day in infants & >200g/24 hour in older children which
lasts <14 days [Nelson]
- Passage of three or more loose/liquid stools per day (or more frequent passage than is normal for the individual).
[WHO]
Classifications
1. Based on duration : Acute (<2w), persistent (2-4w), chronic(>4w)
2. Based on mechanism : Osmotic, secretory & invasive
Inflammatory/non-inflammatory

Inflammatory Diarrhea Non-Inflammatory Diarrhea

Clinical presentation Small-volume, bloody diarrhea Large volume, watery diarrhea
Lower abdominal cramping/pain Upper/paraumbilical abdominal pain or cramp
Fecal urgency Possible nausea/vomiting
Tenesmus
Sometimes, fever
Presence of fecal Yes No
leukocytes
Common causes Shigella, Campylobacter, Salmonella, Vibrio, Giardia, Cryptosporidia, Enterotoxigenic
E histolytica, Yersinia, E.coli, Rotavirus, Norwalk virus, toxigenic food
Enteroinvasive E coli, C. difficile poisoning (S aureus, C perfringens, B cereus)

Etiology B) Malabsorption of carbohydrate

A) Infectious agents (>90%)
Often accompanied by vomiting, fever, abdominal
pain. C) Allergy
1. Virus Example: Cows milk protein sensitive
- Most common agents of viral diarrhea in enteropathy (CMPSE)
child & adults D) Food poisoning
i. Rotavirus (Primarily in child 3-15 mo) E) Immunodeficiency (AIDS)
ii. Norwalk virus F) Others
- Anatomical defect : malrotation
2. Bacteria - Hirchsprungs disease
i. E.coli (20%-30%) - Short bowel syndrome
- Enteropathogenic E.coli (EPEC) Risk Factor
- Enterotoxigenic E. coli (ETEC) - Environmental contamination
- Enteroinvasive E. coli (EIEC) (Drinking water, sanitation & hygiene)
cause dysentriform diarrhea - Contact with enteropathogen
- Enterohaemorrhagic E.coli (EHEC) - Malnutrition
- Enteroadhaeren E.coli (EAEC) - Low breastfeeding
- Immunization status
ii. Shigella (10%)
iii. Campylobacter Bloody Epidemiology in Indonesia & world
iv. Salmonella diarrhea [WHO]
v. Yersinia dysentriform diarrhea
- Diarrhea is a leading cause of malnutrition in
vi. Vibrio
children under five years old.

- Each year diarrhea kills around 760 000
3. Parasite
children under five.
i. Entamoeba histolytica (<1%)
ii. Giardia lamblia (usually in 1-5 y/o child) [Indonesia]
iii. Cryptosporidium
- Mortality rate for child less than 5 year old due

to diarrhea is 5% (UNICEF 2013)