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Suggest Treatment For Acute Viral Gastroenteritis
Question: My daughter is 2.5 yrs old, weight 12 kg. She never had any significant digestion problem so far and yet to be exposed to any antibiotic. Within last 1.5 years, two or three times we found very high temperature around her belly and head while rest of the body were normal, that lasted from few hours to couple of days, only once we used medicine to control the temperature through prescription of her doctor. She has been experiencing almost the same for last one week, symptoms are 1. fever (mostly or only around head and belly), recurring almost after every 6 hours 2. Foul smelling stool, sometimes with visibly undigested food taken earlier, 3. Vomiting tendency (is not throwing out), 4. Not interested to take food at all, nothing beyond plain water, 5. Itching in nose and sometimes anal. I admitted her to hospital and IV going on. Urine culture says no growth, waiting for blood culture report. Routine blood tests showed substantial infection (CRP is 35.5), doctor tried cefixine oral first but no improvement seen in 42 hours, then started ceftriaxon (Injecting) 1gram everyday. Again it's been 42 hours, no improvement so to say, now doctor is suggesting stool culture, I am not sure how efficiently and in methodical manner the diagnosis is going on. My novice suspect is stomach infection due to food poisoning or parasite attack. Not in position to argue with current physician but most importantly we really don't know the real cause of the problem yet.
Brief Answer:
Acute viral gastroenteritis...
Detailed Answer:
Hi
Thanks for posting the query, I will try my best to help you with this problem.
After going through the history, I do feel the child could be suffering from Gastroenteritis. This can be either viral or bacterial.
Rotavirus – one of the most common causes of watery, foul smelling loose stools that can persist for weeks. Fever with nausea or vomiting are common at the onset of the illness.
In cases of bacterial gastroenteritis, all the above mentioned symptoms are noticed along with blood in the stools.
Abdominal discomfort is also noticed sometimes due to build up of gas from the partially formed stools inside the intestines. This dilates the intestines and make it painful to the child. This is also one of the reason for the child to refuse the feeds.
CRP raises during acute infection and denotes an active infection. It is of not much significance in the present stage of infection.
Hence, I do personally feel the present infection is of viral in origin, which is also a reason for non response of the infection to the antibiotics. Also, supplementation of Lactobacillus along with the medicines, will reduce most of the abdominal symptoms.
Do not worry! Viral infection is usually self- limiting, which requires only supportive and symptomatic treatment. Let's wait for the stool culture report to come, depending upon the report, rest of the management can be planned accordingly.
Hope I have answered your query; I will be available for the follow up queries.
Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Acute viral gastroenteritis...
Detailed Answer:
Hi
Thanks for posting the query, I will try my best to help you with this problem.
After going through the history, I do feel the child could be suffering from Gastroenteritis. This can be either viral or bacterial.
Rotavirus – one of the most common causes of watery, foul smelling loose stools that can persist for weeks. Fever with nausea or vomiting are common at the onset of the illness.
In cases of bacterial gastroenteritis, all the above mentioned symptoms are noticed along with blood in the stools.
Abdominal discomfort is also noticed sometimes due to build up of gas from the partially formed stools inside the intestines. This dilates the intestines and make it painful to the child. This is also one of the reason for the child to refuse the feeds.
CRP raises during acute infection and denotes an active infection. It is of not much significance in the present stage of infection.
Hence, I do personally feel the present infection is of viral in origin, which is also a reason for non response of the infection to the antibiotics. Also, supplementation of Lactobacillus along with the medicines, will reduce most of the abdominal symptoms.
Do not worry! Viral infection is usually self- limiting, which requires only supportive and symptomatic treatment. Let's wait for the stool culture report to come, depending upon the report, rest of the management can be planned accordingly.
Hope I have answered your query; I will be available for the follow up queries.
Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by :
Dr. Vinay Bhardwaj
Thanks doctor. Really appreciate.
Let me go by your options: it could be bacterial, non responsiveness of two broad spectrum antibiotic for 48 hours is putting this option in question, can we conclude or should we wait for another 24 hours or more with same antibiotic (ceftriaxon)?
It could be viral? Is there any particular test to detect whether viral or bacterial? If we need to depend on stool culture then it is another 72 hours, meanwhile any measure to take?
Can it be anything beyond viral and bacterial? Like parasite?
She is taking almost no food or drink orally now, strongly reacting with full energy. Every 6 hours temp is reaching around 101 or 102. Then she can't take oral paracetamol, getting suppository every time. Is there any contribution in loose stool from suppository? Any suggestion here?
Let me go by your options: it could be bacterial, non responsiveness of two broad spectrum antibiotic for 48 hours is putting this option in question, can we conclude or should we wait for another 24 hours or more with same antibiotic (ceftriaxon)?
It could be viral? Is there any particular test to detect whether viral or bacterial? If we need to depend on stool culture then it is another 72 hours, meanwhile any measure to take?
Can it be anything beyond viral and bacterial? Like parasite?
She is taking almost no food or drink orally now, strongly reacting with full energy. Every 6 hours temp is reaching around 101 or 102. Then she can't take oral paracetamol, getting suppository every time. Is there any contribution in loose stool from suppository? Any suggestion here?
Brief Answer:
It is better to continue with antibiotics...
Detailed Answer:
Hi
Thanks for writing back
1. I would prefer to continue with the antibiotics for two reasons: a). The efficacy of the antibiotic reaches the peak only after 72 hours from the time of instillation into the body. b). It will prevent an impending secondary bacterial infection after a viral infection. Hence, we can continue with the antibiotic and wait till the lab reports arrive.
2. Routine stool examination can be done to look for the parasites, if any. This a very simple examination and doesn't take much time to report.
3. Viral or bacterial infection can be identified with stool culture and also the type of virus affecting the child.
4. Refusal of feeds in children are common during the episodes of fever and loose stools. Try to give her plenty of liquids in the form of fruit juice and oral rehydration salts.
5. Lactobacillus supplements reduce the formation of gas in the abdomen and improves the consistency of stools.
6. Instead of suppositories request your doctor to give intravenous paracetamol for the fever. Suppositories are irritation for the children and the anus may become sore in some kids.
7. Finally, I would insist in continuing with the antibiotic and wait for the culture report. Meanwhile, encourage your child to drink plenty of liquids. Stool formation will be watery as there is no solid food intake at present. Do not worry! Your child will improve soon. As the reports are normal, I doubt any other infective causes in her case.
Hope this clarifies your doubts. I wish your child a good health and speedy recovery.
Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
It is better to continue with antibiotics...
Detailed Answer:
Hi
Thanks for writing back
1. I would prefer to continue with the antibiotics for two reasons: a). The efficacy of the antibiotic reaches the peak only after 72 hours from the time of instillation into the body. b). It will prevent an impending secondary bacterial infection after a viral infection. Hence, we can continue with the antibiotic and wait till the lab reports arrive.
2. Routine stool examination can be done to look for the parasites, if any. This a very simple examination and doesn't take much time to report.
3. Viral or bacterial infection can be identified with stool culture and also the type of virus affecting the child.
4. Refusal of feeds in children are common during the episodes of fever and loose stools. Try to give her plenty of liquids in the form of fruit juice and oral rehydration salts.
5. Lactobacillus supplements reduce the formation of gas in the abdomen and improves the consistency of stools.
6. Instead of suppositories request your doctor to give intravenous paracetamol for the fever. Suppositories are irritation for the children and the anus may become sore in some kids.
7. Finally, I would insist in continuing with the antibiotic and wait for the culture report. Meanwhile, encourage your child to drink plenty of liquids. Stool formation will be watery as there is no solid food intake at present. Do not worry! Your child will improve soon. As the reports are normal, I doubt any other infective causes in her case.
Hope this clarifies your doubts. I wish your child a good health and speedy recovery.
Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Above answer was peer-reviewed by :
Dr. Bhagyalaxmi Nalaparaju
Hi doctor
Routine check report of stool says pus cell is high (6), now her specialist doctor is suspecting rota virus, and going to dignosis over this suspect further. Meanwhile my daughter is having flooded sweating (just like taking bath) every time fever is leaving her after auppository. Stool has become very watery and foul smelly and she expresses her discomfort every time she is sitting for stool. Urine seems normal. Fever recurrs every 6 hrs upto 102 deg. Now what to do?
Routine check report of stool says pus cell is high (6), now her specialist doctor is suspecting rota virus, and going to dignosis over this suspect further. Meanwhile my daughter is having flooded sweating (just like taking bath) every time fever is leaving her after auppository. Stool has become very watery and foul smelly and she expresses her discomfort every time she is sitting for stool. Urine seems normal. Fever recurrs every 6 hrs upto 102 deg. Now what to do?
Brief Answer:
Fever will come down soon...
Detailed Answer:
Hi
Thanks for writing back
The cysts and ova of the parasites are normally noticed in the routine stool examination. Pus cells denote infection in the intestine which may be either viral or bacterial.
The viral infection is usually accompanied by high temperature unlike bacterial which subsides with antibiotic. Profuse sweating is common once the temperature falls down, hence, do not worry about this.
The normal duration of the viral infection ranges from 5-7 days, with or without the use of antibiotic.
It's a XXXXXXX of relief! The urine formation and out put is normal. Let's wait for the stool culture report to come.
As mentioned in the previous response, request your doctor to add on lactobacillus and give injectable paracetamol. Ensure adequate hydration, the child will feel more better.
I wish her good health and speedy recovery.
Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
Fever will come down soon...
Detailed Answer:
Hi
Thanks for writing back
The cysts and ova of the parasites are normally noticed in the routine stool examination. Pus cells denote infection in the intestine which may be either viral or bacterial.
The viral infection is usually accompanied by high temperature unlike bacterial which subsides with antibiotic. Profuse sweating is common once the temperature falls down, hence, do not worry about this.
The normal duration of the viral infection ranges from 5-7 days, with or without the use of antibiotic.
It's a XXXXXXX of relief! The urine formation and out put is normal. Let's wait for the stool culture report to come.
As mentioned in the previous response, request your doctor to add on lactobacillus and give injectable paracetamol. Ensure adequate hydration, the child will feel more better.
I wish her good health and speedy recovery.
Regards
Dr. Naveen Kumar N.
ENT and Head & Neck Surgeon
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Above answer was peer-reviewed by :
Dr. Vaishalee Punj
Answered by
Dr. Dr. Naveen Kumar Nanjasetty
Otolaryngologist / ENT Specialist
Practicing since :2001
Answered : 2543 Questions
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