C1328568

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For a 7-month-old infant presenting with explosive diarrhea and mucus in stools, here's a concise overview of paediatric management, organized by likely causes, red flags, and stepwise treatment:

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💡 Key Clinical Assessment

• Duration: Acute (<14 days) or Chronic (>14 days)

• Hydration status: Alertness, urine output, skin turgor, capillary refill

• Associated symptoms: Fever, vomiting, blood in stool, poor feeding, failure to thrive

• Feeding history: Breast/formula feeding, recent weaning/solids, cow’s milk introduction

• Travel/exposure history, recent antibiotics, sick contacts

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🦠 Common Causes

Cause	Clues
Viral gastroenteritis	Fever, vomiting, watery diarrhea, often self-limited
Bacterial (Shigella, Salmonella, Campylobacter)	Mucus ± blood, systemic illness possible
Food protein-induced enterocolitis syndrome (FPIES)	Post new food exposure, vomiting + diarrhea
Cow’s milk protein allergy (CMPA)	Chronic mucus, blood, eczema, formula-fed infant
Antibiotic-associated diarrhea	Recent antibiotics, suspect C. difficile
Giardiasis / Parasites	Chronic diarrhea, failure to thrive, travel

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🚩 Red Flags Needing Urgent Evaluation

• Lethargy, sunken eyes, no tears/urine

• Persistent vomiting

• Blood in stool

• Bilious vomiting

• Fever >39°C or toxic appearance

• Abdominal distension

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📋 Initial Workup

• Stool tests: Routine microscopy, culture, occult blood, reducing substances (if malabsorption suspected)

• CBC, CRP/ESR (if systemic signs)

• Electrolytes, BUN, creatinine (for dehydration)

• Consider stool PCR panel if available

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💧 Management Approach

1. Hydration

• Oral Rehydration Solution (ORS) for mild to moderate dehydration

• IV fluids (e.g., NS bolus, then D5 ½ NS with KCl) if severe dehydration

2. Nutritional Support

• Continue breastfeeding or formula

• Avoid unnecessary dietary restriction unless suspecting CMPA or FPIES

3. Treat Cause (if identified)

• Bacterial (Shigella/Campylobacter): Treat if systemic illness or confirmed pathogen

  • E.g., Azithromycin or Cefixime depending on sensitivity/local guidelines

• Giardiasis: Metronidazole

• CMPA/FPIES: Trial of extensively hydrolyzed or amino acid-based formula

• Probiotics: May help reduce duration in viral diarrhea

4. Monitoring & Follow-Up

• Daily weight, input/output charting

• Watch for signs of complications (e.g., dehydration, electrolyte imbalances)

• Reassess if symptoms persist beyond 7-10 days or worsen

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🧠 Pearl

Explosive diarrhea with mucus in an infant often points to infectious etiology or food-related intolerance/allergy. Always consider CMPA in formula-fed infants with chronic mucus/bloody stools.

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