Gastroenteritis
This is a case of a 4-month-old male with no significant past medical history, born at full term
who presented to the emergency department with reports of a fever and loose stools. The
patient’s mother reported that the onset of symptoms was 6 hours prior to presentation and
the temperature at home was 39C. The patient had no sick contacts; no recent travel, no
pets at home, and all immunizations were up to date. Initial VS were significant for a rectal
temperature of 39.3C and an HR of 200 BPM. Physical exam showed yellowish stools with
streaks of blood, all other findings were unremarkable.
Laboratory findings were significant for an elevated absolute neutrophil count
(17.38×10^3/mcl), an elevated absolute lymphocyte count (1.72 x 10^3/mcl), and an elevated
CRP (2.0 mg/dL). Urinalysis was normal and the patient was negative for influenza, COVID-19,
and RSV. XRay of chest/ abdomen showed no acute abnormalities. The patient was admitted
to the pediatric in-patient floor for further evaluation and a stool culture was ordered.
On the pediatric floor, the patient was given Paracetamol and IV fluid for hydration. Asepsis
evaluation including lumbar puncture with CSF cultures and blood cultures was performed on
hospital day 2. Stool cultures obtained were positive for Salmonella species. After a discussion
with a pediatric infectious disease specialist, it was decided that the patient would be placed
on IV ceftriaxone. The patient’s diarrhea began decreasing on hospital day 5 and stools
remained non-bloody for more than 24 hours. Blood culture and CSF cultures showed no
growth after 2 days. The patient’s intake increased to 4 oz of full-strength formula every 4 hrs.
After the patient was afebrile for approximately 36 hours, he was discharged on hospital day 6
and placed on azithromycin per orem for a duration of 5 days.
PATHOPHYSIOLOGY
Gastroenteritis is an intestinal infection that causes watery diarrhea, stomach pains, nausea or
vomiting, and, in rare cases, fever. Contact with an infected person or consumption of
contaminated food or water is the most frequent method to get viral gastroenteritis, often
known as stomach flu. If a person is otherwise healthy, healing can occur without difficulties.
However, viral gastroenteritis can be fatal in newborns, the elderly, and people with weak
immune systems. Viral gastroenteritis is frequently contracted through eating or drinking
contaminated food or water, as well as exchanging utensils, towels, or food with someone
infected with one of the condition's viruses. The following viruses can cause gastroenteritis:
Noroviruses Children and adults are also afflicted, and it is the leading cause of foodborne
disease globally. Norovirus infection has the potential to spread throughout families and
communities. It is more likely to spread in restricted settings.
Rotavirus is the most prevalent cause of viral gastroenteritis in children, who become sick when
they put their contaminated fingers or other things into their mouths. It can also be transmitted
through contaminated food. Infants and young toddlers are more vulnerable to the virus.
Adults who are infected with rotavirus may not show symptoms, but they can still spread the
disease. This is especially concerning in institutional settings such as nursing homes, because
persons infected with the virus may inadvertently spread the illness to others. In certain places,
notably the United States, a vaccination against viral gastroenteritis is available, and it looks to
be successful in preventing illness.
Astrovirus may infect people of all ages, although it is more common in newborns and young
children. The infection is more frequent in the winter and spreads by fecal-oral transfer.
Adenovirus most commonly affects children under the age of 2. Infections occur year-round
and increase slightly in the summer. The infection is spread by fecal-oral transmission.
Bacterial gastroenteritis (food poisoning) – Food that has not been properly cooked or kept
can grow germs on its surface, and these bacteria can release unpleasant substances known as
toxins. If a youngster consumes germ-infested food, the germs or their unpleasant metabolites
cause gastroenteritis symptoms. Furthermore, certain aggressive bacteria, such as
Campylobacter, Salmonella, or E. Even in children who are normally robust and healthy, E. coli
0157 can cause more severe types of food poisoning that result in high fever, severe
gastrointestinal symptoms, and dehydration.
Intestinal parasites – Intestinal parasites can be transmitted to children through filthy hands,
soiled toys and lavatory fixtures, and contaminated water or food. The parasite that causes
giardiasis, Giardia lamblia, is the most prevalent parasitic cause of diarrhea among children in
the United States, particularly those in child care centers.
RISK FACTORS
Gastroenteritis may afflict persons of all ages and happens all over the world. People who are
more prone to gastroenteritis include:
• Young children. Because it takes time for a kid's immune system to grow, children at
child care centers or primary schools may be more vulnerable.
• Older adults. Adult immune systems tend to grow less effectively as they age. Nursing home
residents are susceptible because their immune systems have weakened. They also dwell in
close quarters with people who may spread diseases.
• Schoolchildren or dormitory residents. Anywhere where people congregate in close
quarters might provide a setting for an intestinal illness to spread.
• Anyone with a weakened immune system. If your immune system is impaired due to
HIV/AIDS, chemotherapy, or another medical condition, you may be more vulnerable to
infection.
SIGNS AND SYMPTOMS
Although usually referred to as stomach flu, gastroenteritis is not the same as influenza. The
flu (influenza) solely affects your respiratory system, including your nose, throat, and lungs.
Gastroenteritis, on the other hand, affects your intestines and causes symptoms such as:
• Watery, usually non-bloody diarrhea — bloody diarrhea usually means you have a
different, more severe infection
• Nausea, vomiting or both
• Stomach cramps and pain
• Occasional muscle aches or headache
• Low-grade fever
Depending on the origin, viral gastroenteritis symptoms can range from mild to severe and
develop between 1-3 days of infection. Symptoms normally last a day or two, although they can
persist up to 14 days in rare cases. Because the symptoms are similar, it's easy to confuse viral
diarrhea with diarrhea caused by bacteria like Clostridioides difficile, salmonella, and E. coli, or
parasites like giardia.
DIAGNOSTIC TESTS
Lumbar puncture (LP) with examination of cerebrospinal fluid (CSF) is an important diagnostic
tool for a variety of infectious and noninfectious neurologic conditions.
Spinal tap (lumbar puncture) a meningitis diagnosis that necessitates a spinal tap to obtain
cerebrospinal fluid (CSF). The CSF of meningitis patients frequently has a low sugar (glucose)
level, as well as an elevated white blood cell count and protein level.
A CSF analysis is a collection of tests that examine your cerebrospinal fluid to aid in the
diagnosis of illnesses and ailments affecting the brain and spinal cord.
TREATMENT
The treatment for Gastroenteritis depends on the cause, but may include:
• Plenty of fluids.
• Oral rehydration drinks, available from your pharmacist.
• Admission to hospital and intravenous fluid replacement, in severe cases.
• Antibiotics, if bacteria are the cause.
• Drugs to kill the parasites, if parasites are the cause.
• Avoiding anti-vomiting or anti-diarrhea drugs unless prescribed or recommended by
your doctor, because these medications will keep the infection inside your Body.
NURSING MANAGEMENT
• Assess stool characteristics, The interview with the family should include precise
information on the child's bowel patterns and the beginning of diarrheal stools, including the
amount and kind of stools each day; provide terminology to describe the color and odor of
feces to help the caregiver with descriptions.
• Assess for vomiting to inquire about recent feeding patterns, nausea, and vomiting.
• Assess for presence of illness by asking the caregiver about fever and other signs of illness
in the child and signs of illness in any other family members.
• Physical examination, Skin turgor and condition, including excoriated diaper region,
temperature, anterior fontanelle, apical pulse rate, feces, irritability, lethargy, vomiting,
urine, lips and mucous membranes of the mouth, eyes, and other significant physical
indications are all part of the examination of the kid.
DRUG STUDY
Paracetamol
Mechanism of Action
The central analgesic action of paracetamol is due to the stimulation of descending
serotonergic pathways. Its major mechanism of action is unknown; however it might be
suppression of prostaglandin (PG) production or an active metabolite affecting cannabinoid
receptors.
Indication
Paracetamol is a moderate analgesic and antipyretic that is used to treat a variety of
painful and febrile illnesses, such as headaches, toothaches, neuralgia, colds and influenza,
sore throats, backaches, rheumatic pain, and dysmenorrhea.
Contraindications
Patients who have a known allergy or idiosyncratic response to paracetamol should avoid using
it. Other potentially hepatotoxic medicines or pharmaceuticals that trigger liver microsomal
enzymes, such as alcohol and anticonvulsant treatments, may enhance the risk of paracetamol
poisoning.
Adverse Reactions
Although hematological responses have been observed, paracetamol side effects are
uncommon and typically minor. Rashes on the skin and hypersensitivity responses are common.
If left untreated, paracetamol overdosage can cause serious, perhaps deadly liver damage and,
in rare cases, acute renal tubular necrosis.
Ceftriaxone
Mechanism of Action
Ceftriaxone acts by preventing the bacterial cell wall from producing mucopeptides. Ceftriaxone
binds to carboxypeptidases, endopeptidases, and transpeptidases in the bacterial cytoplasmic
membrane with its beta-lactam component. These enzymes are involved in cell division and cell
wall formation.
Indication
Acute otitis media, UTIs, septicemia, pelvic inflammatory disease (PID), intraabdominal
infections, meningitis, and uncomplicated gonorrhea are all susceptible bacterial infections of
the lower respiratory tract, skin and skin structure, bone and joint.
Contraindication
Patients with diarrhea caused by Clostridium difficile germs, hemolytic anemia, liver difficulties,
gallbladder illness, severe renal impairment, and yellowing of the skin in a newborn infant
should not use this medication.
Adverse Reactions
Rashes, diarrhea, nausea, vomiting, upset stomach, blood clots, dizziness, headache, discomfort
or swelling in the tongue, lump where the drug was injected, sweating, and other adverse
effects are common.
Azithromycin
Mechanism of Action
A macrolide antibiotic, azithromycin inhibits bacterial protein synthesis, quorum sensing, and
lowers biofilm formation. It accumulates in cells, especially phagocytes, and is transported in
high quantities to infection sites, as evidenced by quick plasma clearance and widespread tissue
distribution.
Indication
Azithromycin is used to treat respiratory, urogenital, cutaneous, and other bacterial
infections, as well as to treat chronic inflammatory conditions such diffuse panbronchiolitis,
post-transplant bronchiolitis, and rosacea.
Contraindications
Patients with diarrhea caused by Clostridium difficile germs, low magnesium and potassium
levels in the blood, myasthenia gravis, hearing loss, torsades de pointes, and other
conditions should not use this medication.
Adverse Reactions
The primary ingredient in the medicine, azithromycin, can cause severe or life-threatening
allergic reactions, irregular heartbeats, Clostridium difficile-associated diarrhea, and liver
damage, among other things. Nausea or vomiting, diarrhea, and stomach discomfort are the
most prevalent adverse effects.
REFERENCES:
• https://www.mayoclinic.org/diseases-conditions/viral-
gastroenteritis/symptomscauses/syc20378847#:~:text=Overview,or%20vomiting%2C%20and%
20sometim es%20fever.
• https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/gastroenteriti s
•
