Pediatric Infectious Diarrhea and Dehydration

Diarrhea is a common emergency department (ED) complaint, leading to more than 1.5 million outpatient visits and 200,000 hospital admissions in the United States alone. Although concomitant dehydration also exists in some cases, there are no standard clinical criteria to aid in identifying those children who merit intravenous resuscitation. Current pediatric volume repletion guidelines are based primarily on the estimated degree of volume depletion per the World Health Organization, Centers for Disease Control and Prevention, and American Academy of Pediatrics criteria. These practice guidelines stratify patients into mild (3 to 5% volume depletion), moderate (5 to 10% volume depletion), and severe (> 10% volume depletion). The vast majority of pediatric patients presenting with nausea, vomiting, and/or diarrhea suffer from virus-mediated enterocolitis and require no testing or intravenous fluid resuscitation due to the self-limiting nature of these syndromes; rotavirus and Norwalk virus are two of the most common causes of infectious diarrhea in both developing and developed countries. Although bacterial pathogens rarely cause infectious colitis, children who present with more