What is the treatment for diarrhea in a 13-year-old?

Treatment of Diarrhea in a 13-Year-Old

The primary treatment for diarrhea in a 13-year-old consists of oral rehydration therapy (ORT), continued feeding, and possibly loperamide if the patient is immunocompetent with watery diarrhea, but antimotility drugs should be avoided if there is fever or inflammatory diarrhea. 1, 2

Rehydration Strategy

Assessment of Dehydration

First, assess the level of dehydration:

• Mild dehydration (3-5%): Increased thirst, slightly dry mucous membranes
• Moderate dehydration (6-9%): Loss of skin turgor, dry mucous membranes
• Severe dehydration (≥10%): Lethargy, altered consciousness 3

Rehydration Protocol

1. For mild to moderate dehydration:

   • Use oral rehydration solution (ORS)
   • For mild: 50 mL/kg over 2-4 hours
   • For moderate: 100 mL/kg over 2-4 hours 3
   • Administer in small volumes (5-10 mL) every 1-2 minutes if vomiting is present, gradually increasing the amount 1

2. For severe dehydration:

   • Isotonic intravenous fluids (lactated Ringer's or normal saline) until pulse, perfusion, and mental status normalize
   • Then transition to ORS 1, 3

Nutritional Management

• Continue normal feeding during or immediately after rehydration 1, 3
• Recommended foods: Starches, cereals, yogurt, fruits, and vegetables 1, 3
• Avoid: Foods high in simple sugars and fats 1
• Do not restrict food as early refeeding decreases intestinal permeability and improves outcomes 3

Medication Options

For a 13-year-old:

1. Loperamide may be used for watery diarrhea in immunocompetent adolescents:

   • Initial dose: 4 mg (two capsules)
   • Followed by 2 mg (one capsule) after each unformed stool
   • Maximum daily dose: 16 mg (eight capsules) 2
   • Important caveat: Avoid if fever or inflammatory diarrhea is present 1

2. Ondansetron may be given if vomiting is present:

   • Helps facilitate oral rehydration
   • Recommended for children >4 years of age 1, 3
   • Typical dose: 4 mg as a single dose, can be repeated if vomiting persists 3

3. Probiotics may be offered to reduce symptom severity and duration 1

4. Antibiotics are not routinely recommended unless:

   • Bloody diarrhea (dysentery) is present
   • High fever persists
   • Watery diarrhea lasts >5 days 1, 3

Home Management

1. Fluid replacement:

   • Replace ongoing stool losses with ORS until diarrhea resolves 1
   • For each watery stool: Administer approximately 10 mL/kg of ORS 1
   • For each episode of vomiting: Administer approximately 2 mL/kg of ORS 1

2. Warning signs requiring immediate medical attention:

   • Bloody diarrhea
   • Persistent vomiting
   • Signs of severe dehydration
   • Altered mental status
   • High fever 3

3. Prevention of spread:

   • Hand hygiene after using the toilet, before and after preparing food, and after handling garbage 1

Common Pitfalls to Avoid

1. Do not allow a thirsty child to drink large volumes of ORS at once; administer in small amounts 1

2. Do not use inappropriate fluids like sports drinks, juices, or sodas due to improper electrolyte composition 3

3. Do not use antimotility drugs if there is fever or inflammatory diarrhea 1

4. Do not restrict food during diarrheal episodes 1, 3

5. Do not routinely use antibiotics unless specifically indicated 1, 4

By following this approach, most cases of diarrhea in a 13-year-old can be effectively managed with good outcomes. The focus should remain on adequate hydration and nutrition while monitoring for warning signs that would necessitate more intensive medical intervention.