Acute and Chronic Diarrhea

Definitions & Types - The Runs Rundown

• Duration Classifications:
  • Acute Diarrhea: Lasts <14 days.
  • Persistent Diarrhea: Lasts 14-29 days.
  • Chronic Diarrhea: Lasts ≥30 days.
• Major Pathophysiological Types: Osmotic, Secretory, Inflammatory, Dysenteric (📌 OSID).
• Stool Osmotic Gap (SOG): $290 - 2 \times (Stool\ Na^+ + Stool\ K^+)$.
  • Osmotic: SOG > 100 mOsm/kg.
  • Secretory: SOG < 50 mOsm/kg.

⭐ In India, Rotavirus is the most common cause of severe dehydrating diarrhea in children <2 years.

Acute Diarrhea: Causes & Signs - Bugs & Bellyaches

Common Pathogens & Features:

WHO Dehydration Assessment:

• No Dehydration: <5% wt loss. Alert, drinks normally.
• Some Dehydration: 5-10% wt loss. Restless, irritable, drinks eagerly.
• Severe Dehydration: >10% wt loss. Lethargic, sunken eyes, drinks poorly/unable.

Red Flags:

• Persistent vomiting
• Severe dehydration signs
• Bloody stools
• High fever
• No improvement >48h

Etiological Approach:

Acute Diarrhea: Management - Quenching The Thirst

Primary goal: Rehydration using Oral Rehydration Solution (ORS). WHO-ORS Composition (mOsm/L):

Dehydration Management Plan:

• Zinc: Supplement 10mg daily (<6mo) or 20mg daily (>6mo) for 14 days.
• Antibiotics: Indicated for dysentery (shigellosis), suspected cholera, or specific pathogen.
• Avoid: Antidiarrheals (e.g., loperamide) and antiemetics are generally not recommended.
• Nutrition: Continue breastfeeding/age-appropriate diet; avoid BRAT diet.
• Prevention: Hand hygiene, safe water, Rotavirus vaccination.

⭐ Zinc supplementation in acute diarrhea reduces duration and severity of the episode and prevents future episodes.

Chronic Diarrhea: Etiology - The Long Haul

Defined as diarrhea lasting ≥30 days.

Common Causes & Stool Characteristics in Indian Children:

• Celiac disease
• H (H.pylori - not a cause, but a common GI differential)
• Rotavirus (post-infectious)
• Other (Cystic Fibrosis, IBD)
• Nutrition (Toddler's diarrhea)
• Intolerance (Lactose)
• Cow's milk protein allergy

⭐ Toddler’s diarrhea is characterized by painless passage of loose stools with undigested food particles in a thriving child.

Chronic Diarrhea: Investigation - Detective Work

⭐ Elevated IgA anti-tissue transglutaminase (anti-tTG) antibodies are highly specific for Celiac Disease screening.

High‑Yield Points - ⚡ Biggest Takeaways

• Acute diarrhea: most commonly viral (e.g., Rotavirus); Oral Rehydration Solution (ORS) is the cornerstone of management.
• Persistent diarrhea lasts >14 days; requires investigation for secondary infections or malabsorption.
• Chronic diarrhea lasts >4 weeks; consider Celiac disease, lactose intolerance, or Inflammatory Bowel Disease (IBD).
• Red flag signs in diarrhea include blood or mucus in stool, severe dehydration, persistent vomiting, and failure to thrive.
• Celiac disease screening involves IgA anti-tissue transglutaminase (anti-tTG) antibodies; diagnosis confirmed by duodenal biopsy.
• Lactose intolerance can be diagnosed by a hydrogen breath test or clinical improvement with lactose elimination.
• Toddler's diarrhea (chronic non-specific diarrhea) is typically benign, often linked to excessive fruit juice intake or a low-fat, high-fiber diet.