Episode 36 - Diagnosis and Management of Acute Gastroenteritis in the Emergency Department

<p class="p1">Acute Gastroenteritis- Author: Dr. Brian Geyer</p> <p class="p1">Introduction: </p> <p class="p1"></p> <ul class="ul1"> <li>Do both vomiting and diarrhea have to be present? No <ul class="ul1"> <li class="li1">1996 AAP guidelines, 2016 ACG guidelines, and 2017 IDSA guidelines all note diarrhea illness but may be vomiting predominant. </li> </ul> </li> <li>Studies use more vague definitions like: <ul class="ul1"> <li class="li1"><u>&gt;</u> 1 episode of vomiting and/or <u>&gt;</u> 3 episodes of diarrhea in 24 hours without known chronic cause like inflammatory bowel disease. </li> <li class="li1">Diarrhea is at least 3 unformed stools per day. </li> <li class="li1">Acute episode &lt;14 days </li> <li class="li1">Persistent episode 14-29 days </li> <li class="li1">Chronic diarrhea &gt;29 days </li> </ul> </li> <li>Patients in the ED may present with only some of these symptoms depending their time in course of illness. </li> </ul> <p class="p1">Literature Review: </p> <ul class="ul1"> <li>There is abundant literature on pediatric AGE but sparse research on AGE in adults. Therefore, many recommendations are extrapolated from the pediatric literature. </li> </ul> <p class="p1">Causes: </p> <ul class="ul1"> <li>70% of US cases are estimated to be caused by viruses, norovirus being most common. <ul class="ul1"> <li class="li1">o 26% norovirus </li> <li class="li1">o 18% rotavirus </li> </ul> </li> <li>Among bacterial causes: <ul class="ul1"> <li class="li1">o 5.3% Salmonella, most common </li> <li class="li1">o 5.3% Clostridium </li> <li class="li1">o 3% Campylobacter </li> <li class="li1">o 3% parasitic infections </li> </ul> </li> <li>Large portion, 51%, have no cause identified. (In ED patients) </li> <li>Interestingly, 79% of cases never have a cause identified (not ED specific) </li> <li>In ED patients, only 25% ever have a cause identified, this increases to 49% when a stool sample is obtained. (not ED specific) </li> <li>Food poisoning is responsib