Acute diarrhea natural history, complications and prognosis
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Chandrakala Yannam, MD [2]
Overview
If left untreated, patients with Acute diarrhea may progress to develop symptoms of fluid depletion including altered consciousness, electrolyte imbalance, dehydration, metabolic acidosis and malnutrition. Common complications of acute diarrhea include confusion, convulsions, sepsis, and death. Prognosis is generally good when the underlying cause is identified and treated early.
Natural History
- If left untreated, the patient with Acute diarrhea will develop symptoms and signs of dehydration (dry mouth and tongue, sunken eyes, confusion, lethargy, poor skin turgor, delayed capillary refill), electrolyte imbalance, metabolic acidosis and eventually the patient will deveop hypovolemic shock, coma or death.
Complications
- Common complications of acute diarrhea include:
- Examples of certain postinfectious manifestations associated with some enteric pathogens include:
- Erythema nodosum
- Aortitis, osteomyelitis, extravascular deep tissue focus
- Ekiri syndrome (lethal, toxic encephalopathy) and/or seizure
- Intestinal perforation
- Salmonella including Salmonella Typhi, Shigella, Campylobacter, Yersinia, Entamoeba histolytica
- Meningitis
- Listeria, Salmonella (infants ≤3 months of age are at high risk)
- Postinfectious irritable bowel syndrome
- Reactive arthritis
- Salmonella, Shigella, Campylobacter, Yersinia, rarely Giardia, and Cyclospora cayetanensis
- Immunoglobulin A nephropathy
- Hemolytic uremic syndrome
- Hemolytic anemia
- Guillain-Barré syndrome
- Glomerulonephritis
Prognosis
Acute diarrhea is usually self limiting and has good prognosis when the underlying cause is identified and treated. The presence of these features in a patient with acute diarrhea over 2 weeks may indicate poor prognosis. [1] [2]
- Weight loss
- Immunosupression
- Hemolytic uremic syndrome with EHEC infection
- Gullian barre syndrome with Campylobacter infection
- Toxic megacolon
- old age
References
- ↑ Karmali MA, Petric M, Lim C, Fleming PC, Arbus GS, Lior H (1985). "The association between idiopathic hemolytic uremic syndrome and infection by verotoxin-producing Escherichia coli". J. Infect. Dis. 151 (5): 775–82. PMID 3886804.
- ↑ Nylund CM, Denson LA, Noel JM (2010). "Bacterial enteritis as a risk factor for childhood intussusception: a retrospective cohort study". J. Pediatr. 156 (5): 761–5. doi:10.1016/j.jpeds.2009.11.026. PMID 20138300.