1. Postinfectious gastroenteritis. Elemental formulas (ie, lactose-free with hydrolyzed amino acids and medium-chain triglycerides) usually improve absorption across damaged intestinal epithelium. Severe cases may require continuous nasogastric feeding or TPN.
2. Chronic, nonspecific diarrhea. Often responds to high-fat diet and reduction in clear fluid intake.
3. Lactose intolerance. Dietary exclusion of lactose-containing foods. In infants, a lactose-free formula can be used temporarily during acute illness. In older children, use of LactAid tablets and products can be used on a more permanent basis.
5. Milk-protein allergy. Because of the high cross-reactivity between milk and soy protein, switching to a soy formula is usually ineffective. Most patients respond to an elemental formula (ie, protein hydrolysate formula) and should be maintained on this for 1 year before performing a challenge. Prognosis is excellent, with most infants tolerating milk-containing products by 1-2 years of age.
Irritable bowel syndrome. Therapy consists of high-fiber diet, fiber supplements, antispasmodic agents, and behavioral modification (eg, relaxation techniques).
IBD. Treatment depends on location and severity of the inflamed bowel and should be determined by a pediatric gastroenterologist.
Celiac disease, fat malabsorption, and pancreatic disorders. If suspected, referral to a pediatric gastroenterologist is indicated.
VI. Problem Case Diagnosis. The 9-month-old boy had acute viral gastroenteritis complicated by dehydration. Physical exam was unremarkable except for dry mucous membranes, absence of tears, and poor skin turgor. He responded well to two boluses of IV fluids before tolerating adequate oral fluids.
VII. Teaching Pearl: Question. What clinical and simple laboratory findings are useful in differentiating between viral and bacterial enteritis?
VIII. Teaching Pearl: Answer. Vomiting before the onset of diarrhea and large, watery, and relatively infrequent stools suggest viral gastroenteritis. Fever, abdominal pain, and frequent, small-volume, and often bloody stools containing mucus and leukocytes are more commonly seen in bacterial enteritis.
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