Abstract:
I describe two children with chronic diarrhea who had multiple admissions and numerous nondiagnostic procedures before the correct diagnosis of factitious diarrhea caused by laxative ingestion or diet manipulation by a parent was discovered. Report of Cases .—Case1.—This was the fifth hospitalization because of vomiting and diarrhea for this 23-month-old female infant. Her mother had four previous miscarriages because of prematurity. The mother and father had separated before the birth of this child, and the child and mother lived alone. By history, the child had unexplained fever and had passed ten to 15 watery stools each day since infancy. The patient was pale and irritable, and her weight and height had fallen from the 50th to the fifth percentile. During this hospitalization, the child had watery, pink-tinged stools that averaged 250 g/day. An extensive evaluation disclosed that the following studies yielded normal findings: complete blood cell (CBC) count,Cite
Sir .—We were interested to read the report by J. W. Paisley and colleagues in theJournal(132:34, 1978) describing the clinical manifestations of influenza virus A 2 infections in young children. This article confirms several of the findings in our own published report of a similar group of children in hospital. 1 The main findings of both studies are compared in the accompanying Table. In our study, gastrointestinal symptoms were the usual presentation in babies aged younger than 6 months of age. Fifty percent of the babies in this age group, nine of 18, had diarrhea and vomiting or diarrhea. Two babies required intravenous fluids and one had severe hypernatremic dehydration. Thus, of the 17 children who had diarrhea and vomiting or diarrhea alone, only four were older than 6 months of age. The higher incidence of convulsions in our series, 37%, is mainly due to the higher
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Case Report: A 44-year-old man ingested about 40 flowers of Colchicum autumnale L. The patient presented with nausea, vomiting, and abdominal pain 2 hours after ingestion and had diarrhea 14 hours after ingestion. Hematological values remained within normal range. Treatment was mainly supportive. The outcome was favorable. The intoxication was confirmed by high-performance liquid chromatography–mass spectrometry. Maximal colchicine levels were 4.34 ng/mL at 13 hours in plasma and 5.43 ng/mL at 16 hours in erythrocytes. Conclusion: We report one of the few symptomatic cases of Colchicum autumnale L. poisoning confirmed by toxicological analysis.
Colchicine
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Introduction: Diarrhea is one of the most common causes of morbidity and mortality of children worldwide, especially in developing countries. Acute diarrhea can occur from a large number of causes. We aim to describe the clinical manifestation characteristics of acute diarrhea on pediatric patients that are presented to the hospital.Methods: A cross-sectional study from all pediatric patients treated in Dr. Soetomo General Hospital Surabaya in 2011-2013.Age, gender, nutritional status, length of hospital stay, duration of breastfeeding, clinical signs and symptoms, as well as laboratory results collected and analyzed descriptively.Results: One hundred and fifty patients were included with characteristics of male(54%), infant (55.3%)with a mean age of 6-7 month. History of being exclusively breastfed(54%) and lack of nutrition(48%). Vomiting is mostly present (72.7%) and commonly come with a combination of two symptoms (42%) which were vomiting and fever. Mild to severe dehydration degree could be found on the patient who had vomiting, seizure, and fever. The most length of stay was frequently >72 hours. The occurrence of acute diarrhea on a child who was treated in Dr. Soetomo General Hospital Surabaya is dominated by vomiting and it could be inferred that the most acute diarrhea has a tendency of being caused by a virus, where liquid acute diarrhea without blood, mucus, or fever is found.Conclusion: The etiology of acute diarrhea is mostly caused by viruses and symptoms dominated by a combination of vomiting, fever, and diarrhea without blood caused by villi damage.
Etiology
Acute diarrhea
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Copper is an essential element for all living beings. Exposure to copper results almost exclusively from the ingestion of food and water. Generally, potable water contains low levels of copper, but high concentrations of this mineral have been found in water from private wells or when water or beverages with low pH have been conducted through copper piping. Some authors have associated acute gastrointestinal symptoms (diarrhea, abdominal pain, nausea, and vomiting) with elevated levels of copper in water or beverages, but without excluding other confounding factors that could produce such symptoms. Recently, various controlled studies have demonstrated that a concentration of 2 mg Cu/L of potable water does not produce an increase in gastrointestinal symptoms in infants, and that in women, only concentrations greater than 3 mg Cu/L increase the number of episodes of nausea, vomiting, and abdominal pain, but not diarrhea. This critical analysis of scientific publications verifies the WHO provisional level for copper in drinking water (2 mg/L) as safe for human health.
Potable water
Mineral water
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I describe two children with chronic diarrhea who had multiple admissions and numerous nondiagnostic procedures before the correct diagnosis of factitious diarrhea caused by laxative ingestion or diet manipulation by a parent was discovered. Report of Cases .—Case1.—This was the fifth hospitalization because of vomiting and diarrhea for this 23-month-old female infant. Her mother had four previous miscarriages because of prematurity. The mother and father had separated before the birth of this child, and the child and mother lived alone. By history, the child had unexplained fever and had passed ten to 15 watery stools each day since infancy. The patient was pale and irritable, and her weight and height had fallen from the 50th to the fifth percentile. During this hospitalization, the child had watery, pink-tinged stools that averaged 250 g/day. An extensive evaluation disclosed that the following studies yielded normal findings: complete blood cell (CBC) count,
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Celiac disease (CD) may be missed or diagnosed late in children with chronic diarrhea. In this study the authors estimated the frequency of CD among pediatric patients with chronic diarrhea based on serologic and pathologic examinations.During a 6-year period, all patients with chronic diarrhea of more than 6 weeks referred to the authors' department were included. For each patient, an asymptomatic control was enrolled from among the patients referred to our clinic for other reasons. Serologic tests for CD including immunoglobulin A endomysial antibody and immunoglobulin A antigliadin antibody were performed in all patients and controls. If positive, duodenal biopsy was performed to confirm the diagnosis. Patients subsequently diagnosed as CD were placed on a gluten-free diet and reevaluated after 6 months.825 cases of diarrhea and 825 controls were enrolled. CD was diagnosed in 54 (6.5%) of the diarrhea patients and seven (0.8%) of the controls. After 6 months of gluten-free diet, 48 (88.8%) patients had significant improvement in symptoms and of these 41 (76.1%) were totally asymptomatic. Forty-two patients allowed repeat endoscopy after 6 months of gluten-free diet and 40 (95.2%) showed improvement in histologic findings.CD is common among patients labeled as chronic diarrhea. In this subgroup, gluten-free diet may lead to a significant improvement in symptoms. Routine testing for CD may be indicated in all patients being evaluated for chronic diarrhea.
Chronic diarrhea
Gluten free
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Patients with chronic diarrhea should be carefully questioned about their diet. A correlation may be found between gastrointestinal symptoms and the ingestion of coffee, milk, or sugars such as sorbitol and fructose. If the offending agent can be identified and withdrawn from the diet, the diarrhea will stop and further evaluation can be avoided.
Chronic diarrhea
Acute diarrhea
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Chronic diarrhea in young children requires long multi-stage diagnosis, which often results in delayed therapy and, as a consequence, poorer quality of life. Objective. To identify risk factors for chronic diarrhea in young children. Patients and methods. This study included 70 children with chronic diarrhea and 70 healthy children matched for main characteristics. Results. We identified the following predictors of chronic diarrhea in young children: chronic genitourinary infections during pregnancy, Cesarian section, late initiation of breastfeeding, early initiation of formula feeding, and antibacterial therapy in the neonatal period. Family history of food intolerance and allergic diseases were also found to be significant risk factors for chronic diarrhea in young children (food-dependent forms of diarrhea). Key words: chronic diarrhea, young children, risk factors
Chronic diarrhea
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