What Are the Most Common Causes of Morning Diarrhea?

Infant diarrhea is a gastrointestinal dysfunction in infants and young children. The main symptoms are diarrhea and vomiting. The incidence is highest in summer and autumn. The pathogenic factors of the disease are divided into three aspects: physical fitness, infection and digestive dysfunction. The main clinical manifestations are increased stool frequency, defecation and water and electrolyte disorders. If the disease is properly treated, it has a good effect, but it can endanger the life of children when it is not treated in time or serious water and electrolyte disorders occur.

Basic Information

Visiting department: Gastroenterology
Multiple groups: Infants

Common causes: Physical, infection and digestive disorders
Common symptoms: Increased stool frequency, defecation, water and electrolyte disorders

Causes of infant diarrhea

Physical factors

The disease mainly occurs in infants and young children, and its internal characteristics are:

(1) The infant's gastrointestinal tract development is not mature enough, the enzyme activity is low, but the nutritional requirements are relatively large, and the gastrointestinal tract is burdened.

(2) Nervous, endocrine, circulatory system, and liver and kidney functions are immature during infancy, with poor regulation.

(3) The immune function of infants is not perfect. Serum E. coli antibody titers were lowest from birth to 2 years of age, and gradually increased thereafter. Therefore, infants and young children are susceptible to E. coli enteritis. Escherichia coli antibody titers in breast milk are high, especially pathogenic E. coli secreted IgA is high in colostrum, so breast-fed infants have less incidence and less illness. In the same way, infants have low rotavirus antibodies. When the same group is endemic, infants are more ill.

(4) The distribution of infant's body fluids is different from that of adults. The extracellular fluid accounts for a high proportion, and the water metabolism is strong, and the regulating function is poor. It is more prone to body fluid and electrolyte disorders. Babies are susceptible to rickets and malnutrition, which can cause digestive disorders. At this time, intestinal secretory IgA is insufficient, and it is easy to persist after diarrhea.

2. Infectious factors

Divided into the digestive tract and extradigestive tract infection, the former mainly.

(1) Infection in the digestive tract Pathogenic microorganisms can enter the digestive tract of children with contaminated food or water, and are therefore prone to occur in artificially fed children. If the utensils or food used during feeding are not disinfected or disinfected, infection may also occur. The virus can also infect through the respiratory tract or water. The second is infection by adults who carry bacteria (toxins) and become asymptomatic intestinal carriers (toxins), which can cause the transmission of pathogens.

(2) Infections outside the digestive tract Infections of organs and tissues outside the digestive tract can also cause diarrhea, which is common in otitis media, pharyngitis, pneumonia, urinary tract infections, and skin infections. Most diarrhea is not serious, the younger the more common. Part of the cause of diarrhea is due to digestive dysfunction caused by extra-intestinal infection, and the other part may be caused by infection of the same pathogen (mainly virus) inside and outside the intestine.

(3) The intestinal flora is affected by long-term use of broad-spectrum antibiotics such as chloramphenicol, kanamycin, gentamicin, ampicillin, and various cephalosporins, especially when two or more are used in combination. In addition to directly stimulating the intestinal tract or stimulating autonomic nerves to cause intestinal peristalsis to increase, glucose absorption to decrease, disaccharide enzyme activity to reduce diarrhea, and more serious can cause intestinal flora disorders. At this time, the normal intestinal E. coli disappears or is significantly reduced, and at the same time, drug-resistant Staphylococcus aureus, Proteus, Pseudomonas aeruginosa, Clostridium difficile, or Candida albicans can multiply in large quantities, causing drugs that are difficult to control. enteritis.

3. Digestive disorders

(1) Dietary factors.

(2) Intolerance to carbohydrates.

(3) Food allergies.

(4) Drug effects.

(5) Other factors: such as unclean environment, too little outdoor activities, sudden changes in living rules, sudden changes in external climate (known as "wind, cold, summer, wet diarrhea" by Chinese medicine), etc., also easily cause infant diarrhea.

Clinical manifestations of infant diarrhea

The main clinical manifestations are increased stool frequency, defecation and water and electrolyte disorders.

General symptoms

Varies by diarrhea.

(1) Mild diarrhea is mainly caused by increased stool frequency, several times a day to more than 10 times. Stool is thin, sometimes with a small amount of water, yellow or yellow-green, mixed with a small amount of mucus. The amount is small, white or light yellow small pieces are common, the soap is a combination of calcium, magnesium and fatty acids. Occasionally vomiting or galactorrhea, loss of appetite, normal body temperature, or occasionally low fever. She is pale and has good spirits and no other symptoms. No weight gain or slight loss. Body fluid loss is below 50ml / kg, and clinical dehydration symptoms are not obvious. The prognosis is good, the course of disease is 3 to 7 days.

(2) Severe diarrhea can be caused by light weight. Defecate ten to 40 times a day. When it starts to change to heavy, the water in the stool will increase, with occasional mucus, yellow or yellow-green, smelly, acidic reaction. If the diaper is not changed in time, the skin of the buttocks will often be corroded, and the epidermis will peel off and become red. As the illness worsens and food intake decreases, the stool odor decreases, the stool disappears and it becomes watery or egg-flower soup-like, and becomes lighter in color. The main components are intestinal fluid and a small amount of mucus, which show an alkaline reaction. The stool volume is increased to 30ml each time, and more can reach 50ml. Under the microscope, fat droplets, swimming bacteria, mucus, and occasionally red blood cells were seen, and white blood cells reached about 10 per high-power field of view. Children have low appetite, often accompanied by vomiting. Irregular low fever, severe high fever. She quickly lost weight and lost weight. If fluid is not replenished in time, dehydration and acidosis will gradually increase. A few severe illnesses are acute, with high fever of 39 ° C to 40 ° C, frequent vomiting and watery stools, and symptoms of water and electrolyte disturbances appear rapidly. In the past ten years or more, due to early consultations, severe severe diarrhea has been significantly reduced.

2. Symptoms of water and electrolyte disturbances

Mainly dehydration, acidosis, and sometimes symptoms of low potassium and low calcium.

(1) Dehydration The child loses weight quickly, loses weight, loses spirit, pale or even gray, poor elasticity, depression of the anterior condyle and eye sockets, dry mucous membranes, sunken abdomen, pulse count, decreased blood pressure, and decreased urine output. Dehydration is divided into light, medium and heavy degrees: Mild dehydration Loss of body fluids accounts for less than 5% of body weight. The child's spirit is slightly worse, his complexion is slightly pale, his skin is slightly dry but his elasticity is good, his eye sockets are slightly sunken, and his urine is slightly less than usual. Moderate dehydration. Body fluid loss accounts for about 5% to 10% of body weight. The patient was agitated, irritable, and had pale, gray, dry, loose, and poor elasticity, which could not be flattened immediately after being pinched. The mouth is blue, the front palate and eye sockets are drooping, the lips and mucous membranes are dry, the heart sounds are dull, the abdomen is concave, the limbs are cold, and the urination is significantly reduced; The child is apathetic, indifferent, has no response to the surrounding environment, has pale gray skin, and is extremely poor in elasticity. The anterior palate and the eye socket are deeply depressed, the eyes are not closed, the conjunctiva is dry, there is no tears, the cornea is dull, the lips are cyanotic, the mucous membrane is dry, unclear, heart rate, and blood pressure is not easy to measure. Abdomen is sunken. Cold limbs. Little or no urine.

When estimating the degree of dehydration, attention should be paid to the degree of depression of the eye socket and anterior condyle. Hypotonic dehydration is prone to decrease in skin elasticity, and malnutrition children usually have poor elasticity, which should be paid attention to.

(2) Acidosis is mainly a loss of energy and deep breathing. In severe cases, breathing becomes faster and even coma. Newborns or small babies do not have deep breathing at a later stage or later, mainly manifested as drowsiness, paleness, antifeeding, and weakness, etc. It is estimated that the age of the child should be paid attention to when acidosis occurs.

(3) Hypokalemia Hypokalemia usually occurs more than 1 week after watery diarrhea, and those who are malnourished originally appear earlier and heavier. Generally, children do not have symptoms of hypokalemia before infusion. After input of potassium-free liquid, with the correction of dehydration acidosis, hypokalemia symptoms gradually appear: mental weakness, low muscle tone, and first heart sound dull. Re-emphasis occurs abdominal distension, bowel sounds weakened or disappeared, tendon reflexes weakened. If potassium is not supplemented in time, muscle paralysis or even respiratory muscle paralysis, intestinal paralysis, bladder paralysis, tendon reflexes disappear, heart rate slows, arrhythmia, systolic murmurs in the apex, and heart enlargement can be life-threatening when hypokalemia is severe. . Hypokalemia often occurs in serum potassium below 3.5mmol / L.

(4) Hypocalcemia Children with chronic malnutrition, rickets, or chronic diarrhea often have hypocalcemia symptoms such as irritability, convulsions in hands, feet, and convulsions. Examination showed positive Foster's and peroneal reflexes.

(5) Hypomagnesemia A small number of children corrected hand-foot twitch with hypomagnesia after dehydration, acidosis, and calcium supplementation. Manifestations include tremor, convulsions, crying, irritation, and inability to fall asleep.

Infant diarrhea examination

Blood test

2. Stool microscopy

Indigestion patients have fat droplets or a small amount of mucus. Enteritis patients have leukocytes and occasional red blood cells and phagocytic cells. Fungal enteritis can be seen with fungal crocuses and hyphae. Pathogens can be isolated by culture.

Diagnosis of infant diarrhea

Make a diagnosis based on clinical manifestations and related tests.

Complications of infant diarrhea

Diarrhea often results in malnutrition, multivitamin deficiency, multiple infections, and water and electrolyte disturbances, as well as impaired heart, liver, and kidney function.

Extradigestive tract infection

Extra-gastrointestinal infections may be the cause of diarrhea, but they are also often infected due to low general immunity after diarrhea. Common skin purulent infections, urinary tract infections, otitis media, upper respiratory tract infections, bronchitis, pneumonia, phlebitis, and sepsis. Viral enteritis is occasionally complicated by myocarditis.

2. Thrush

Thrushes are prone to be complicated by children with a prolonged course of disease or previous malnutrition, especially after long-term use of broad-spectrum antibiotics. If the drug is not stopped in time, fungi can invade the intestine and even cause systemic fungal disease.

3. Toxic hepatitis

Jaundice can occur during the course of diarrhea, which is more common in children with existing malnutrition. Enteritis caused by E. coli may be complicated by E. coli sepsis, leading to toxic hepatitis. The condition worsened quickly after diarrhea and died soon after jaundice. However, if early detection of polymyxin, ampicillin or carbenicillin is found early, most can be cured.

4. Malnutrition and Vitamin Deficiency

Long-lasting diarrhea, or repeated repeated fasting and chronic caloric deficiency, can easily lead to malnutrition, anemia, and vitamin A deficiency. Chronic diarrhea caused impaired liver function, reduced vitamin K absorption and reduced prothrombin, and caused bleeding.

5. Other

Acute renal failure can be complicated by severe dehydration. In addition, there are toxic intestinal paralysis, intestinal hemorrhage, intestinal perforation, intussusception and gastric dilatation. It can also cause acute heart failure, hypernatremia or hyponatremia, or hyperkalemia due to improper infusion. Infant vomiting can cause suffocation.

Infant diarrhea treatment

Principles: prevent dehydration, correct dehydration, continue diet, and rational medication

Diet therapy

Continue the original diet, mainly light and easy to digest, and appropriately reduce complementary food. If you have lactose intolerance or allergic diarrhea, you need to switch to lactose-free milk powder and deep hydrolyzed or free amino acid milk powder.

Fluid therapy

(1) Oral method Applicable to those with mild to moderate dehydration or severe vomiting.

(2) intravenous fluid replacement method for moderate to severe dehydration.

3. Control infection

According to the cause, rational selection of antibacterial drugs.

4. Symptomatic treatment

Diarrhea can be taken orally with montmorillonite powder. Digestion can be oral pepsin mixture, or multi-enzyme tablets. Treat symptomatically.

Prognosis of infant diarrhea

The prognosis of infantile diarrhea is related to the child's constitution, etiology, timing and treatment methods.

Infant diarrhea prevention

Pay attention to feeding, enhance physical fitness, pay attention to food hygiene, and add complementary food to the baby, it should be gradually. Avoid contact with children with diarrhea.