Acute gastroenteritis(AGE): Symptoms, Diagnosis & Treatments

The AGE may show vomiting or lack of vomiting with decreased bowel consistency and increased bowel movements (eg, three or more dilute or watery bowel movements during the day). The duration is usually less than a week and symptoms last longer than two weeks. It is a common illness that almost every child experiences one or more AGE episodes before becoming two. AGE is mostly caused by infectious cause, 70% of which is due to virus and the rest is bacterial or parasitic etiology. Non-infectious causes include certain drugs such as NSAIDs, lactose, gluten, and Crohn's disease. Originally, rotavirus was the most common cause, but now rotavirus vaccination is becoming common and norovirus is the leading cause. E. coli, Salmonella, Shigella species, C. difficile, Campylobacter jejuni, C. upsaliensis and Mycobacterium avium complex, and parasite of Giardia, Cryptosporidium, Cystoisospora belli, Microsporidia and Cyclospora cause non-viral AGE. Clinical symptoms include diarrhea, abdominal pain, abdominal cramps, nausea, vomiting, fever, anorexia, headache, and muscular pain. Depending on the causative organism, the stool may be accompanied. It is usually caused by a virus that is not a virus. AGE may cause complications such as hypovolemia, dehydration, electrolyte imbalance, acid-base imbalance, and carbohydrate disturbance. Frequent diarrhea may result in systemic shock or multiorgan dysfunction if rehydration is not performed immediately after dehydration. Younger children (<2years) are more sensitive to dehydration and require more special attention. Diagnosis is mainly clinical, and lab tests are not required for children with normal immunity. It is because the treatment does not change much if the causative bacteria are identified. Once diagnosed, the severity of the AGE should be determined and treated accordingly. The severity of the AGE depends on how severe the dehydration is. It is also very important to measure the electrolyte concentration in the serum to make sure that PO hydration alone is not enough and IV hydration is a necessary condition. Most AGEs have acute and self-limiting characteristics and can be solved only by conservative treatment. Mild to moderate dehydration with oral rehydration therapy, and severe dehydration with intravenous rehydration. It is recommended not to give soft drinks or juices that cause diarrhea. In some cases, the use of antiemetics such as ondansetron can help to resolve nausea and vomiting, or to control abdominal pain using butylscopolamine. Food should be kept as usual, but foods containing a lot of monosaccharides should be avoided. Probiotics or zinc preparations may also be used to reduce diarrhea. Antibiotics are usually used in children with bloody diarrhea and fever (WHO recommendations), but no antibiotics are commonly used in AGE.

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