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Diarrhea accounts for approximately 500,000,000 deaths per year in developing countries. In the US it accounts for 10% of outpatients visits. Unlike adults, toddlers get dehydrated faster due to diarrhea which leads to complications which can be fatal.

Diarrhea accounts for 10% of outpatients visits

Prompt assessment of the severity of dehydration and correcting it with intravenous fluids or oral dehydration therapy solution not only corrects dehydration and serious complications but also prevents death in these children.

What is diarrhea?

Diarrhea is children defined as increased total daily stool output.  It is usually associated with an increase in the water content of stool.  The normal stool output in a toddler is 5-10 g /kg /day. A toddler is said to be having diarrhea if the daily stool output is more than 10g per kg body weight. It is also defined as loose, watery, unformed stools occurring more than three times in a day. If a toddler occasionally passes loose stool or passes stool more frequently which are well formed it is not called diarrhea.

Types of diarrhea

Based on the mechanism, diarrhea in toddlers is broadly classified in to the following groups.

Osmotic diarrhea – This is caused by presence of substances which are nonabsorbable in the gastrointestinal tract. The substance which is not absorbed results in water drawn in to the lumen of the gastrointestinal tract resulting in diarrhea. Some of the causes of osmotic diarrhea are:

  • Lactose intolerance
  • Intake of carbonated fluids
  • Intake of sorbitol, magnesium hydroxide

Secretory diarrhea – In this type of diarrhea certain factors act on the intestinal wall and stimulate them to secrete water in to the lumen. Some of the causes of secretory diarrhea are:

  • Bacterial infections - Cholera
  • Viral infections  - Rota virus
  • Others – Bile salts, hormone (gastrin, vasoactive intestinal polypeptide) induced

There are a few simple methods to find the type of diarrhea that the toddler is suffering from. It is osmotic diarrhea:

  • If there is improvement in symptoms with fasting
  • If the stool test positive for reducing substances
  • If the diarrhea is of small volume (less than 200 ml per day)
Continue reading after recommendations

  • Nelson Textbook of Pediatrics, 18th edition

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