Diseases » Shigellosis » Causes

Causes of Shigellosis

Causes of Shigellosis (Diseases Database):

The follow list shows some of the possible medical causes of Shigellosis that are listed by the Diseases Database:

• Shigella boydii
• Shigella dysenteriae
• Shigella flexneri
• Shigella sonnei

Source: Diseases Database

Shigellosis Causes: Book Excerpts

• Differential Diagnosis - Diarrhea - Acute
• Differential Diagnosis - Diarrhea - Chronic
• Differential Diagnosis - Diarrhea – Chronic, No Blood or Weight Loss
• Differential Diagnosis - Diarrhea – Chronic, with Weight Loss
• Differential Diagnosis - Diarrhea – Acute
• Medical causes - Diarrhea
• Causes and incidence - Shigellosis
• Causes and incidence - Poisonous snakebites
• Medical causes - Diarrhea
• Differential Overview - Acute Diarrhea
• Differential Overview - Chronic Diarrhea
• Causes - Snakebites, poisonous
• Medical causes - Diarrhea
• Medical causes - Diarrhea
• Principle Causes of Acute Diarrhea - Diarrhea
• Medical causes - Diarrhea
• Food Poisoning or Foodborne Illness - pathophysiology - Food Poisoning or Foodborne Illness
• Sympathomimetic Poisoning - risk factors - Sympathomimetic Poisoning

What causes Shigellosis?

Causes: Shigellosis: Shigella bacterial infection of the digestive tract.
The disease is caused when virulent Shigella organisms attach to, and penetrate, epithelial cells of the intestinal mucosa. After invasion, they multiply intracellularly, and spread to contiguous epitheleal cells resulting in tissue destruction. Some strains produce enterotoxin and Shiga toxin (very much like the verotoxin of E. coli O157:H7). (Source: FDA Bad Bug Book)
Article excerpts about the causes of Shigellosis:

Foodborne Infections General: DBMD (Excerpt)

Later in food processing, other foodborne microbes can be introduced from infected humans who handle the food, or by cross contamination from some other raw agricultural product.  For example, Shigella bacteria, hepatitis A virus and Norwalk virus can be introduced by the unwashed hands of food handlers who are themselves infected.  In the kitchen, microbes can be transferred from one food to another food by using the same knife, cutting board or other utensil to prepare both without washing the surface or utensil in between.  A food that is fully cooked can become recontaminated if it touches other raw foods or drippings from raw foods that contain pathogens.  (Source: excerpt from Foodborne Infections General: DBMD)

Shigellosis (General): DBMD (Excerpt)

Shigellosis is particularly common and causes recurrent problems in settings where hygiene is poor and can sometimes sweep through entire communities. Shigellosis is more common in summer than winter. Children, especially toddlers aged 2 to 4, are the most likely to get shigellosis. Many cases are related to the spread of illness in child-care settings, and many more are the result of the spread of the illness in families with small children.

In the developing world, shigellosis is far more common and is present in most communities most of the time. (Source: excerpt from Shigellosis (General): DBMD)

Medical news summaries relating to Shigellosis:

The following medical news items are relevant to causes of Shigellosis:

• Natural disaster continuing death toll
• More news »

Related information on causes of Shigellosis:

As with all medical conditions, there may be many causal factors. Further relevant information on causes of Shigellosis may be found in:

• Risk factors for Shigellosis
• Contagiousness for Shigellosis
• Hidden causes of Shigellosis

Causes of Shigellosis: Online Medical Books

16 MEDICAL BOOKS ONLINE! Review excerpts from medical books online, free, without registration, for more information about the causes of Shigellosis.

Diarrhea - Acute: Differential Diagnosis
(In a Page: Signs and Symptoms)

• Infectious etiologies
  –Acute (viral) gastroenteritis
  –“Traveler's diarrhea”: Shigella, Salmonella, enterotoxigenic E. coli, Campylobacter
  –Rotavirus
  –Norwalk virus
  –Yersinia enterocolitica
  –Clostridium difficile (pseudomembranous enterocolitis): Follows antibiotic use
  –Giardiasis: Foul-smelling, explosive diarrhea
  –Enterovirus
• Lactose intolerance
• IBS: Alternating diarrhea and constipation
• Ischemic colitis: Associated with history of atherosclerotic disease (CAD, PVD, AAA)
• Inflammatory bowel disease (ulcerative colitis, Crohn's disease)
• Medications (e.g., laxatives, antibiotics, anticholinergics, chemotherapy, metformin)
• Malabsorption syndromes
• Vasculitis
• Neoplasia
• Appendicitis
• Adrenal insufficiency
• Hyperthyroidism
• HIV
• Less common etiologies include E. coli O157:H7 (commonly associated with raw meat; invasive, bloody diarrhea), Cryptosporidium, Cyclospora, Isospora belli, typhoid fever

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Diarrhea - Chronic: Differential Diagnosis
(In a Page: Signs and Symptoms)

• Diarrhea due to deranged motility presents with alternating diarrhea and constipation, bloating, mucus or blood in the stool, relief of abdominal pain upon defecation, worsening diarrhea with stress
  –IBS: Usually presents in the morning, seldom at night; more common in women; rectal urgency
  –Diabetic neuropathy: Uncontrolled, explosive, postprandial diarrhea; usually seen in patients with neurologic dysfunction and uncontrolled blood sugar
  –Hyperthyroidism
  –Postileal resection
  –Scleroderma
  –Carcinoid syndrome: Diaphoresis and diarrhea
• Secretory diarrhea will persist even after a 48–72 hour fast; stool osmotic gap <50
  –Bacterial gastroenteritis
  –Bile acid malabsorption
  –Colitis
  –Hyperthyroidism
  –Collagen vascular diseases (SLE, MCTD, scleroderma)
  –Neuroendocrine tumors (e.g., VIPoma, gastrinoma, carcinoid)
• Osmotic diarrhea will cease upon fasting; stool osmotic gap >100 mOsm/kg
  –Malabsorption (celiac sprue, nontropical sprue, Whipple's disease)
  –Nonabsorbable substances (e.g., laxatives, lactose, magnesium)

Inflammatory diarrhea presents with blood and mucus in the stools, urgency, fevers
–Inflammatory bowel disease
–Behçet syndrome
–Invasive bacterial disease (Campylobacter jejuni)
–Intestinal neoplasm

'>

» READ BOOK EXCERPT ONLINE »

Source: In a Page: Signs and Symptoms, 2004

Diarrhea – Chronic, No Blood or Weight Loss: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• Osmotic: Presence of nonabsorbable solute, pH <5, volume <200 mL/day, normal electrolytes, stops with fasting
• Secretory: Mostly due to toxins, pH >6, volume >200 mL/day, no response to fasting, stool Na >70 mEq/L, negative reducing substances
• Toddler's diarrhea: Chronic nonspecific diarrhea, onset 3 months to 3 years of age, average 4–6 stools daily, due to excessive juice intake or low-fat diet
• Excessive intake of nonabsorbable solutes (lactulose, sorbitol, magnesium hydroxide)
• Congenital lactose deficiency: Very rare in infancy, but may occur in extremely premature infants; adult-onset type of hypolactasia may be seen in older children (over age 5), autosomal recessive, 15% white adults, 85% of black adults, 90% of Asian adults
• Secondary lactase deficiency: Follows a viral gastroenteritis, most commonly rotavirus, may persist for months
• Fructose intolerance
• Sucrase-isomaltase deficiency: Autosomal recessive, found in 0.2% of North Americans, symptoms commence on starting sucrose or glucose polymer-containing foods
• Glucose-galactose malabsorption: Rare, autosomal recessive disorder
• Infections
  –Giardiasis (most common infectious cause of chronic diarrhea in toddlers)
  –Cryptosporidium
  –Microsporidium
• Irritable bowel syndrome (IBS)
  –Abnormality of intestinal motility and pain perception with no organic basis
  –Abdominal pain associated with intermittent diarrhea or constipation
• Bacterial overgrowth: Enteric bacteria colonizes the upper small intestine
• Trehelase deficiency (trehelose is the sugar found in mushrooms)
• Zinc deficiency
  –Acrodermatitis enteropathica is typical rash
• Low-fat diet

'>>

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Diarrhea – Chronic, with Weight Loss: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• Allergic enteritis: Typically cow's milk or soy in infants
• Inflammatory bowel disease (IBD)
• Cystic fibrosis (CF)
  –Chronic diarrhea may be the only sign
  –90% have pancreatic insufficiency (PI)
• Celiac disease (CD): Gluten sensitivity, increased incidence in selective IgA deficiency, DM, and Down syndrome
• Immune deficiency (e.g., hypogammaglobulinemia)
• Sucrase-isomaltase deficiency: Autosomal recessive, symptoms with starting sucrose or glucose polymer-containing diet
• Microvillus inclusion disease: Most common cause of persistent diarrhea in the neonatal period
• Schwachman-Diamond syndrome
  –Pancreatic insufficiency, neutropenia, short stature, skeletal abnormalities
• Johannson-Blizzard syndrome
  –Pancreatic insufficiency, scalp defects, agenesis of nasal cartilage, deafness, imperforate anus
• Whipple disease:
  –Tropheryma whippelii (actinomycete)
  –Diagnosed mainly in adults
  –Weight loss, diarrhea, and arthropathy
• Tropical sprue: Common in developing countries; folate deficiency and diarrhea
• Neural crest tumors: Pheochromocytoma, VIPoma, Zollinger-Ellison syndrome, carcinoid tumors
• Mastocytoma
• Neuroblastoma
• Abetalipoproteinemia
• Giardiasis, Strongyloides, coccidia
• AIDS
• Acrodermatitis enteropathica: Zinc deficiency, acral perioral and perianal rashes, consider underlying cystic fibrosis
• Mutational defects in ion transport proteins
  –Chloride-losing diarrhea: Rare, ileal chloride transport defect, maternal polyhydramnios
  –Congenital sodium diarrhea
• Tufting enteropathy (epithelial dysplasia)
• Enterokinase deficiency

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Diarrhea – Acute: Differential Diagnosis
(In A Page: Pediatric Signs and Symptoms)

• Viral gastroenteritis
  –Rotavirus, most common (winter)
  –Norwalk-like virus
  –Calcivurus
  –Enteric adenovirus
  –Astrovirus
• Bacterial gastroenteritis
  –Campylobacter jejuni (associated with Guillain-Barré syndrome)
  –Salmonella
  –Shigella: May cause seizures (up to 30%), HUS
  –Escherichia coli (various types): Enteropathogenic, enterohemorrhagic (O157:H7) verotoxin can cause HUS (6–8% of cases), enterotoxigenic (traveler's diarrhea), enteroinvasive
  –Clostridium difficile (toxin A or B)
  –Yersinia enterocolitis (mimics acute appendicitis)
  –Vibrio cholerae
  –Aeromonas hydrophila
  –Toxin-mediated food poisoning: Bacillus cereus, Staphylococcus aureus, Clostridium perfringens
  • Parasitic infestations
    –Giardia lamblia
    –Cryptosporidium (severe in AIDS patients)
    –Entamoeba histolytica
  • Food allergies
    –Cow's milk and soy protein allergy are most common in infancy
  • Malbasorption (celiac disease, CF)
  • Lactose or fructose intolerance
  • Overfeeding (relative lactase deficiency)
  • Vitamin deficiency (e.g., niacin )
  • Zinc deficiency
  • Laxative abuse
  • Irritable bowel syndrome
  • Constipation with encopresis
  • Bacterial overgrowth
  • Antibiotics
  • Hirschsprung toxic colitis
  • Adrenogenital syndrome

» READ BOOK EXCERPT ONLINE »

Source: In A Page: Pediatric Signs and Symptoms, 2007

Diarrhea: Medical causes
(Handbook of Signs & Symptoms (Third Edition))

Anthrax, GI

Anthrax manifests after the patient has eaten contaminated meat from an animal infected withBacillus anthracis. Early signs and symptoms include decreased appetite, nausea, vomiting, and a fever. Later signs and symptoms include severe bloody diarrhea, abdominal pain, and hematemesis.

Carcinoid syndrome

With carcinoid syndrome, severe diarrhea occurs with flushing — usually of the head and
neck — that's commonly caused by emotional stimuli or the ingestion of food, hot water, or alcohol. Associated signs and symptoms include abdominal cramps, dyspnea, weight loss, anorexia, weakness, palpitations, valvular heart disease, and depression.

Cholera

After ingesting water or food contaminated by the bacteriumVibrio cholerae,the patient experiences abrupt watery diarrhea and vomiting. Other signs and symptoms include thirst (due to severe water and electrolyte loss), weakness, muscle cramps, decreased skin turgor, oliguria, tachycardia, and hypotension. Without treatment, death can occur within hours.

Clostridium difficile infection

The patient may be asymptomatic or may have soft, unformed stools or watery diarrhea that may be foul smelling or grossly bloody; abdominal pain, cramping, and tenderness; a fever; and a white blood cell count as high as 20,000/ml. In severe cases, the patient may develop toxic megacolon, colon perforation, or peritonitis.

Crohn's disease

Crohn's disease is a recurring inflammatory disorder that produces diarrhea accompanied by abdominal pain with guarding and tenderness and nausea. The patient may also display a fever, chills, weakness, anorexia, and weight loss.

Escherichia coli

Watery or bloody diarrhea, nausea, vomiting, fever, and abdominal cramps occur after the patient eats undercooked beef or other foods contaminated with this particular strain of bacteria. Hemolytic uremic syndrome, which causes red blood cell destruction and eventually acute renal failure, is a complication ofE. coli0157:H7 in children age 5 and younger and elderly people.

Infections

Acute viral, bacterial, and protozoal infections (such as cryptosporidiosis) cause the sudden onset of watery diarrhea as well as abdominal pain, cramps, nausea, vomiting, and a fever. Significant fluid and electrolyte loss may cause signs of dehydration and shock. Chronic tuberculosis and fungal and parasitic infections may produce a less severe but more persistent diarrhea, accompanied by epigastric distress, vomiting, weight loss and, possibly, passage of blood and mucus.

Intestinal obstruction

Partial intestinal obstruction increases intestinal motility, resulting in diarrhea, abdominal pain with tenderness and guarding, nausea and, possibly, distention.

Irritable bowel syndrome

Diarrhea alternates with constipation or normal bowel function. Related findings include abdominal pain, tenderness, and distention; dyspepsia; and nausea.

Ischemic bowel disease

Ischemic bowel disease is a life-threatening disorder that causes bloody diarrhea with abdominal pain. If severe, shock may occur, requiring surgery.

Lactose intolerance

Diarrhea occurs within several hours of ingesting milk or milk products. It's accompanied by cramps, abdominal pain, borborygmi, bloating, nausea, and flatus.

Listeriosis

With listeriosis, diarrhea occurs in conjunction with a fever, myalgia, abdominal pain, nausea, and vomiting. A fever, a headache, nuchal rigidity, and an altered level of consciousness may occur if the infection spreads to the nervous system and causes meningitis. This infection, caused by the ingestion of food contaminated with the bacteriumListeria monocytogenes primarily affects pregnant women, neonates, and those with weakened immune systems. Listeria infections during pregnancy may lead to premature delivery, infection of the neonate, or stillbirth.

Pseudomembranous enterocolitis

Pseudomembranous enterocolitis is a potentially life-threatening disorder that commonly follows antibiotic administration. It produces copious watery, green, foul-smelling, bloody diarrhea that rapidly precipitates signs of shock. Other signs and symptoms include colicky abdominal pain, distention, a fever, and dehydration.

Q Fever

Q Fever is caused by the bacterium Coxiella burnetiiand causes diarrhea along with a fever, chills, a severe headache, malaise, chest pain, and vomiting. In severe cases, hepatitis or pneumonia may follow.

Rotavirus gastroenteritis

Rotavirus gastroenteritis commonly starts with a fever, nausea, and vomiting, followed by diarrhea. The illness can range from mild to severe and can last from 3 to 9 days. Diarrhea and vomiting may result in dehydration.

Thyrotoxicosis

With thyrotoxicosis, nervousness, tremors, diaphoresis, weight loss despite increased appetite, dyspnea, palpitations, tachycardia, an enlarged thyroid, heat intolerance and, possibly, exophthalmos accompany diarrhea.

Ulcerative colitis

The hallmark of ulcerative colitis is recurrent bloody diarrhea with pus or mucus. Other signs and symptoms include tenesmus, hyperactive bowel sounds, cramping lower abdominal pain, a low-grade fever, anorexia and, at times, nausea and vomiting. Weight loss, anemia, and weakness are late findings.

Other causes

Herb alert  

Herbal reme-
dies — such as ginkgo biloba, ginseng, and licorice — may cause diarrhea.

Drugs

Many antibiotics — such as ampicillin, cephalosporins, tetracyclines, and clindamycin — cause diarrhea. Other drugs that may cause diarrhea include magnesium-containing antacids, colchicine, guanethidine, lactulose, dantrolene, ethacrynic acid, mefenamic acid, methotrexate, metyrosine and, in high doses, cardiac glycosides and quinidine. Laxative abuse can cause acute or chronic diarrhea.

Treatments

Gastrectomy, gastroenterostomy, and pyloroplasty may produce diarrhea. High-dose radiation therapy may produce enteritis associated with diarrhea.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Signs & Symptoms (Third Edition), 2006

Shigellosis: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

Transmission occurs through the fecal-oral route; by direct contact with contaminated objects; or through ingestion of contaminated food or water. Occasionally, the housefly is a vector.

Shigellosis is endemic in North America, Europe, and the tropics. In the United States, about 18,000 cases appear annually, usually in children or in elderly, debilitated, or malnourished people. Shigellosis commonly occurs among confined populations, such as those in mental institutions or day-care centers.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Poisonous snakebites: Causes and incidence
(Professional Guide to Diseases (Eighth Edition))

Of the approximately 45,000 snakebites that occur in the United States each year, 7,000 to 8,000 are from poisonous snakes, resulting in 5 to 6 deaths. Such bites are most common during summer afternoons in grassy or rocky habitats.

Pit vipers are nocturnal but active snakes that are responsible for 99% of venomous snake bites in the United States. Coral snakes are also nocturnal, but their placidity makes coral snake bites less common than pit viper bites. Coral snakes tend to bite with a chewing motion, and may leave multiple fang marks, small lacerations, and extensive tissue destruction.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Diseases (Eighth Edition), 2005

Diarrhea: Medical causes
(Professional Guide to Signs & Symptoms (Fifth Edition))

Anthrax, GI

This disease follows ingestion of contaminated meat from an animal infected with Bacillus anthracis. Early signs and symptoms include decreased appetite, nausea, vomiting, and fever. Later signs and symptoms include severe bloody diarrhea, abdominal pain, and hematemesis.

Carcinoid syndrome

In this disorder, severe diarrhea occurs with flushing—usually of the head and neck—that’s commonly caused by emotional stimuli or the ingestion of food, hot water, or alcohol. Associated signs and symptoms include abdominal cramps, dyspnea, anorexia, weight loss, weakness, palpitations, valvular heart disease, and depression.

Cholera

After ingesting water or food contaminated by the bacterium Vibrio cholerae, the patient experiences abrupt watery diarrhea and vomiting. Other signs and symptoms include thirst (due to severe water and electrolyte loss), weakness, muscle cramps, decreased skin turgor, oliguria, tachycardia, and hypotension. Without treatment, death can occur within hours.

Clostridium difficile infection

The patient may be asymptomatic or may have soft, unformed stools or watery diarrhea that may be foul smelling or grossly bloody; abdominal pain, cramping, and tenderness; fever; and a white blood cell count as high as 20,000/µl. In severe cases, the patient may develop toxic megacolon, colonic perforation, or peritonitis.

Crohn’s disease

This recurring inflammatory disorder produces diarrhea, abdominal pain with guarding and tenderness, and nausea. The patient may also display fever, chills, weakness, anorexia, and weight loss.

Escherichia coli O157:H7

Watery or bloody diarrhea, nausea, vomiting, fever, and abdominal cramps occur after the patient eats undercooked beef or other foods contaminated with this particular strain of bacteria. Hemolytic uremic syndrome, which causes red blood cell destruction and eventually acute renal failure, is a complication of E. coli O157:H7 in children age 5 and younger and elderly people.

Infections

Acute viral, bacterial, and protozoal infections (such as cryptosporidiosis) cause the sudden onset of watery diarrhea as well as abdominal pain or cramps, nausea, vomiting, and fever. Significant fluid and electrolyte loss may cause signs of dehydration and shock. Chronic tuberculosis and fungal and parasitic infections may produce a less severe but more persistent diarrhea, accompanied by epigastric distress, vomiting, weight loss and, possibly, passage of blood and mucus.

Intestinal obstruction

Partial intestinal obstruction increases intestinal motility, resulting in diarrhea, abdominal pain with tenderness and guarding, nausea and, possibly, distention.

Irritable bowel syndrome

Diarrhea alternates with constipation or normal bowel function. Related findings include abdominal pain, tenderness, and distention; dyspepsia; and nausea.

Ischemic bowel disease

This life-threatening disorder causes bloody diarrhea with abdominal pain. If severe, shock may occur, requiring surgery.

Lactose intolerance

Diarrhea occurs within several hours of ingesting milk or milk products in patients with this disorder. It’s accompanied by cramps, abdominal pain, borborygmi, bloating, nausea, and flatus.

Large-bowel cancer

In this disorder, bloody diarrhea is seen with a partial obstruction. Other signs and symptoms include abdominal pain, anorexia, weight loss, weakness, fatigue, exertional dyspnea, and depression.

Listeriosis

This infection, caused by ingestion of food contaminated with the bacterium Listeria monocytogenes, primarily affects pregnant women, neonates, and those with weakened immune systems. Characteristic findings include diarrhea, fever, myalgia, abdominal pain, nausea, and vomiting. Fever, headache, nuchal rigidity, and altered level of consciousness may occur if the infection spreads to the nervous system and causes meningitis.

Gender Cue: Listeriosis during pregnancy may lead to premature delivery, infection of the neonate, or stillbirth.

Malabsorption syndrome

Occurring after meals, diarrhea is accompanied by steatorrhea, abdominal distention, and muscle cramps. The patient also displays anorexia, weight loss, bone pain, anemia, weakness, and fatigue. He may bruise easily and have night blindness.

Pseudomembranous enterocolitis

This potentially life-threatening disorder commonly follows antibiotic administration. It produces copious watery, green, foul-smelling, bloody diarrhea that rapidly precipitates signs of shock. Other signs and symptoms include colicky abdominal pain, distention, fever, and dehydration.

Q fever

This infection is caused by the bacterium Coxiella burnetii and causes diarrhea along with fever, chills, severe headache, malaise, chest pain, and vomiting. In severe cases, hepatitis or pneumonia may follow.

Rotavirus gastroenteritis

This disorder commonly starts with a fever, nausea, and vomiting, followed by diarrhea. The illness can be mild to severe and last from 3 to 9 days. Diarrhea and vomiting may result in dehydration.

Thyrotoxicosis

In this disorder, diarrhea is accompanied by nervousness, tremors, diaphoresis, weight loss despite increased appetite, dyspnea, palpitations, tachycardia, enlarged thyroid, heat intolerance and, possibly, exophthalmos.

Ulcerative colitis

The hallmark of this disorder is recurrent bloody diarrhea with pus or mucus. Other signs and symptoms include tenesmus, hyperactive bowel sounds, cramping lower abdominal pain, low-grade fever, anorexia and, possibly, nausea and vomiting. Weight loss, anemia, and weakness are late findings.

Other causes

Drugs

Many antibiotics—such as ampicillin, cephalosporins, tetracyclines, and clindamycin—cause diarrhea. Other drugs that may cause diarrhea include magnesium-containing antacids, colchicine, lactulose, dantrolene, ethacrynic acid, mefenamic acid, methotrexate, metyrosine and, with high doses, cardiac glycosides and quinidine. Laxative abuse can cause acute or chronic diarrhea.

Foods

Foods that contain certain oils may inhibit the food’s absorption, causing acute uncontrollable diarrhea and rectal leakage.

Herb Alert

Herbal remedies, such as ginkgo biloba, ginseng, and licorice, may cause diarrhea.

Lead poisoning

Alternating diarrhea and constipation may be accompanied by abdominal pain, anorexia, nausea, and vomiting. The patient complains of a metallic taste, headache, and dizziness and displays a bluish gingival lead line.

Treatments

Gastrectomy, gastroenterostomy, and pyloroplasty may produce diarrhea. High-dose radiation therapy may produce enteritis associated with diarrhea.

» READ BOOK EXCERPT ONLINE »

Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006

Acute Diarrhea: Differential Overview
(Field Guide to Bedside Diagnosis)

❑ Viral gastroenteritis

❑ Staphylococcal enterotoxin

❑ E. coli

❑ Salmonella

❑ Campylobacter

❑ Drugs

❑ C. difficile colitis

❑ Giardia

❑ Shigella

❑ Yersinia

❑ Entamoeba histolytica

❑ Typhoid fever

❑ Vibrio parahaemolyticus

❑ Cryptosporidia

❑ Cholera

❑ Strongyloides

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Chronic Diarrhea: Differential Overview
(Field Guide to Bedside Diagnosis)

Altered Intestinal Motility

❑ Irritable bowel syndrome

❑ Diabetic enteropathy

Inflammatory

❑ Inflammatory bowel disease

❑ Giardiasis

❑ Cryptosporidiosis

Osmotic

❑ Lactase deficiency

❑ Drugs

❑ Pancreatic insufficiency

❑ Post-gastrectomy

❑ Celiac sprue

❑ Small bowel lymphoma

Secretory

❑ Villous adenoma

❑ Pancreatic cholera

❑ Carcinoid

❑ Zollinger-Ellison syndrome

❑ Medullary carcinoma of the thyroid

» READ BOOK EXCERPT ONLINE »

Source: Field Guide to Bedside Diagnosis, 2007

Snakebites, poisonous: Causes
(Handbook of Diseases)

The only poisonous snakes in the United States are pit vipers (Crotalidae) and coral snakes (Elapidae). Pit vipers include rattlesnakes, water moccasins (cottonmouths), and copperheads. They have a pitted depression between their eyes and nostrils and two fangs, ¾" to 1¼"nbsp;(2 to 3 cm) long. Because fangs may break off or grow behind old ones, some snakes may have one, three, or four fangs.

Because coral snakes are nocturnal and placid, their bites are less common than pit viper bites; pit vipers are also nocturnal but are more active. The fangs of coral snakes are short but have teeth behind them. Coral snakes have distinctive red, black, and yellow bands (yellow bands always border red ones), tend to bite with a chewing motion, and may leave multiple fang marks, small lacerations, and much tissue destruction.

» READ BOOK EXCERPT ONLINE »

Source: Handbook of Diseases, 2003

Diarrhea: Medical causes
(Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series)

Anthrax, GI.

GI anthrax manifests after the patient has eaten contaminated meat from an animal infected with Bacillus anthracis. Early signs and symptoms include decreased appetite, nausea, vomiting, and fever. Later signs and symptoms include severe bloody diarrhea, abdominal pain, and hematemesis.

Carcinoid syndrome.

With carcinoid syndrome, severe diarrhea occurs with flushing — usually of the head and neck — that’s commonly caused by emotional stimuli or the ingestion of food, hot water, or alcohol. Associated signs and symptoms include abdominal cramps, dyspnea, weight loss, anorexia, weakness, palpitations, valvular heart disease, and depression.

Cholera.

After ingesting water or food contaminated by the bacterium Vibrio cholerae, the patient experiences abrupt watery diarrhea and vomiting. Other signs and symptoms include thirst (due to severe water and electrolyte loss), weakness, muscle cramps, decreased skin turgor, oliguria, tachycardia, and hypotension. Without treatment, death can occur within hours.

Clostridium difficile infection

The patient may be asymptomatic or may have soft, unformed stools or watery diarrhea that may be foul-smelling or grossly bloody; abdominal pain, cramping, and tenderness; fever; and a white blood cell count as high as 20,000/µl. In severe cases, the patient may develop toxic megacolon, colonic perforation, or peritonitis.

Crohn’s disease

Crohn’s disease is a recurring inflammatory disorder that produces diarrhea accompanied by abdominal pain with guarding and tenderness, and nausea. The patient may also display fever, chills, weakness, anorexia, and weight loss.

Escherichia Coli O157:H7

Watery or bloody diarrhea, nausea, vomiting, fever, and abdominal cramps occur after the patient eats undercooked beef or other foods contaminated with E. coli O157:H7. Hemolytic uremic syndrome, which causes red blood cell destruction and eventually acute renal failure, is a complication of E. coli O157:H7 in children age 5 and younger and elderly people.

Infections

Acute viral, bacterial, and protozoal infections (such as cryptosporidiosis) cause the sudden onset of watery diarrhea as well as abdominal pain, cramps, nausea, vomiting, and fever. Significant fluid and electrolyte loss may cause signs of dehydration and shock. Chronic tuberculosis and fungal and parasitic infections may produce a less severe but more persistent diarrhea, accompanied by epigastric distress, vomiting, weight loss and, possibly, passage of blood and mucus.

Intestinal obstruction

Partial intestinal obstruction increases intestinal motility, resulting in diarrhea, abdominal pain with tenderness and guarding, nausea and, possibly, distention.

Irritable bowel syndrome

Diarrhea alternates with constipation or normal bowel function. Related findings include abdominal pain, tenderness, and distention; dyspepsia; and nausea.

Ischemic bowel disease.

Ischemic bowel disease is a life-threatening disorder that causes bloody diarrhea with abdominal pain. If severe, shock may occur, requiring surgery.

Lactose intolerance

Diarrhea occurs within several hours of ingesting milk or milk products. It’s accompanied by cramps, abdominal pain, borborygmi, bloating, nausea, and flatus.

Large-bowel cancer

With large-bowel cancer, bloody diarrhea is seen with a partial obstruction. Other signs and symptoms include abdominal pain, anorexia, weight loss, weakness, fatigue, exertional dyspnea, and depression.

Lead poisoning

. Alternating diarrhea and constipation occur with lead poisoning. Other GI effects include abdominal pain, anorexia, nausea, and vomiting. The patient complains of a metallic taste, headache, and dizziness and displays a bluish gingival lead line.

Listeriosis

With listeriosis — an infectious disease —  diarrhea occurs in conjunction with fever, myalgias, abdominal pain, nausea, and vomiting. Fever, headache, nuchal rigidity, and altered level of consciousness may occur if the infection spreads to the nervous system and causes meningitis. This infection, caused by the ingestion of food contaminated with the bacterium Listeria monocytogenes primarily affects pregnant females, neonates, and those with weakened immune systems.

Malabsorption syndrome

Occurring after meals, diarrhea is accompanied by steatorrhea, abdominal distention, and muscle cramps. The patient also displays anorexia, weight loss, bone pain, anemia, weakness, and fatigue. He may bruise easily and have night blindness.

Pseudomembranous enterocolitis.

Pseudomembranous enterocolitis is a potentially life-threatening disorder that commonly follows antibiotic administration. It produces copious watery, green, foul-smelling, bloody diarrhea that rapidly precipitates signs of shock. Other signs and symptoms include colicky abdominal pain, distention, fever, and dehydration.

Q fever.

Q fever is caused by the bacterium Coxiella burnetii and causes diarrhea along with fever, chills, severe headache, malaise, chest pain, and vomiting. In severe cases, hepatitis or pneumonia may occur.

Rotavirus gastroenteritis.

Rotavirus gastroenteritis commonly starts with a fever, nausea, and vomiting, followed by diarrhea. The illness can range from mild to severe and last from 3 to 9 days. Diarrhea and vomiting may result in dehydration.

Thyrotoxicosis.

With thyrotoxicosis, diarrhea is accompanied by nervousness, tremors, diaphoresis, weight loss despite increased appetite, dyspnea, palpitations, tachycardia, enlarged thyroid, heat intolerance and, possibly, exophthalmos.

Ulcerative colitis

The hallmark of ulcerative colitis is recurrent bloody diarrhea with pus or mucus. Other signs and symptoms include tenesmus, hyperactive bowel sounds, cramping lower abdominal pain, low-grade fever, anorexia and, at times, nausea and vomiting. Weight loss, anemia, and weakness are late findings.

Other causes

Drugs

Many antibiotics — such as ampicillin, cephalosporins, tetracyclines, and clindamycin — cause diarrhea. Other drugs that may cause diarrhea include magnesium-containing antacids, colchicine, guanethidine, lactulose, dantrolene, ethacrynic acid, mefenamic acid, methotrexate, metyrosine and, in high doses, cardiac glycosides and quinidine. Laxative abuse can cause acute or chronic diarrhea.

Foods

Foods that contain certain oils may inhibit absorption of food causing acute uncontrollable diarrhea and rectal leakage.

Herbal remedies

Certain herbal remedies, such as ginkgo biloba, ginseng, and licorice, may cause diarrhea.

Medical treatments

Gastrectomy, gastroenterostomy, and pyloroplasty may produce diarrhea. High-dose radiation therapy may produce enteritis associated with diarrhea.

» READ BOOK EXCERPT ONLINE »

Source: Alarming Signs and Symptoms: Lippincott Manual of Nursing Practice Series, 2007

Diarrhea: Medical causes
(Signs & Symptoms: A 2-in-1 Reference for Nurses)

Anthrax, GI

Early signs and symptoms of GI anthrax, an infectious disease caused by eating meat contaminated with the bacterium Bacillus anthracis, include decreased appetite, nausea, vomiting, and fever. Later signs and symptoms include severe bloody diarrhea, abdominal pain, and hematemesis.

Clostridium difficile infection

With a Clostridium difficile infection, the patient may be asymptomatic or may have soft, unformed stools or watery diarrhea that may be foul smelling or grossly bloody; abdominal pain, cramping, and tenderness; fever; and a white blood cell count as high as 20,000/µl. In severe cases, the patient may develop toxic megacolon, colonic perforation, or peritonitis.

Crohn’s disease

Crohn’s disease, a recurring inflammatory disorder, produces diarrhea accompanied by abdominal pain with guarding and tenderness, and nausea. The patient may also display fever, chills, weakness, anorexia, and weight loss.

Escherichia coli 0157:H7

Watery or bloody diarrhea, nausea, vomiting, fever, and abdominal cramps occur after the patient eats undercooked beef or other foods contaminated with the Escherichia coli 0157:H7 strain of bacteria. Hemolytic uremic syndrome, which causes red blood cell destruction and eventually acute renal failure, is a complication of   E. coli 0157:H7 in children age 5 and younger and elderly people.

Infections

Acute viral, bacterial, and protozoal infections (such as cryptosporidiosis) cause the sudden onset of watery diarrhea as well as abdominal pain, cramps, nausea, vomiting, and fever. Significant fluid and electrolyte loss may cause signs of dehydration and shock. Chronic tuberculosis and fungal and parasitic infections may produce a less severe but more persistent diarrhea, accompanied by epigastric distress, vomiting, weight loss and, possibly, passage of blood and mucus.

Intestinal obstruction

Partial intestinal obstruction increases intestinal motility, resulting in diarrhea, abdominal pain with tenderness and guarding, nausea and, possibly, distention. Other signs and symptoms may include borborygmi and rushes on auscultation and vomiting of fecal material.

Irritable bowel syndrome

Diarrhea alternates with constipation or normal bowel function. Related findings include abdominal pain, tenderness, and distention; dyspepsia; and nausea. The patient may also report passage of mucus and pasty pencil-like stools.

Ischemic bowel disease

A life-threatening disorder, ischemic bowel disease causes bloody diarrhea with abdominal pain. The patient may also experience abdominal distention, nausea, and vomiting. If severe, shock may occur, requiring surgery.

Lactose intolerance

Diarrhea occurs within several hours of ingesting milk or milk products. It’s accompanied by cramps, abdominal pain, borborygmi, bloating, nausea, and flatus.

Large-bowel cancer

With large-bowel cancer, bloody diarrhea is seen with a partial obstruction. Other signs and symptoms include abdominal pain, anorexia, weight loss, weakness, fatigue, exertional dyspnea, and depression.

Lead poisoning

Alternating diarrhea and constipation occur in a patient with lead poisoning. Other GI effects include abdominal pain, anorexia, nausea, and vomiting. The patient complains of a metallic taste, headache, and dizziness and displays a bluish gingival lead line.

Malabsorption syndrome

In a patient with malabsorption syndrome, diarrhea occurs after meals, accompanied by steatorrhea, abdominal distention, and muscle cramps. The patient also displays anorexia, weight loss, bone pain, anemia, weakness, and fatigue. He may bruise easily and have night blindness.

Pseudomembranous enterocolitis

Pseudomembranous enterocolitis, a potentially life-threatening disorder, commonly follows antibiotic administration. It produces copious watery, green, foul-smelling, bloody diarrhea that rapidly precipitates signs of shock. Other signs and symptoms include colicky abdominal pain, distention, fever, and dehydration.

Q Fever

Q Fever is an infection that’s caused by the bacterium Coxiella burnetii and causes diarrhea along with fever, chills, severe headache, malaise, chest pain, and vomiting. In severe cases, hepatitis or pneumonia may follow. Chronic Q fever may cause prolonged fever, night sweats, chills, fatigue, and dyspnea.

Rotavirus gastroenteritis

Rotavirus gastroenteritis commonly starts with a fever, nausea, and vomiting, followed by diarrhea. The illness can range from mild to severe and last from 3 to 9 days. Diarrhea and vomiting may result in dehydration.

Thyrotoxicosis

With thyrotoxicosis, diarrhea is accompanied by nervousness, tremors, diaphoresis, weight loss despite increased appetite, dyspnea, palpitations, tachycardia, enlarged thyroid, heat intolerance and, possibly, exophthalmos.

Ulcerative colitis

The hallmark of ulcerative colitis is recurrent bloody diarrhea with pus or mucus. Other signs and symptoms include tenesmus, hyperactive bowel sounds, cramping lower abdominal pain, low-grade fever, anorexia and, at times, nausea and vomiting. Weight loss, anemia, and weakness are late findings.

Other causes

Drugs

Many antibiotics — such as ampicillin, cephalosporins, tetracyclines, and clindamycin — cause diarrhea. Other drugs that may cause diarrhea include magnesium-containing antacids, colchicine, guanethidine, lactulose, dantrolene, ethacrynic acid, mefenamic acid, methotrexate, metyrosine and, in high doses, cardiac glycosides and quinidine. Laxative abuse can cause acute or chronic diarrhea. Herbal remedies — such as ginkgo biloba, ginseng, and licorice — may also cause diarrhea.

Foods

Foods that contain certain oils may inhibit absorption causing acute uncontrollable diarrhea and rectal leakage.

Treatments

Gastrectomy, gastroenterostomy, and pyloroplasty may produce diarrhea. High-dose radiation therapy may produce enteritis, which is associated with diarrhea.

» READ BOOK EXCERPT ONLINE »

Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007

Diarrhea: Principle Causes of Acute Diarrhea
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)

1. Infection
   1. Gastroenteritis
      1. Viral
         1. Rotavirus
         2. Other viruses
      2. Bacterial
         1. Salmonella
         2. Shigella
         3. Campylobacter jejuni
         4. Escherichia coli
         5. Other bacterial pathogens
      3. Parasitic
         1. Giardia lamblia
         2. Entamoeba histolytica
         3. Cryptosporidium parvum
         4. Strongyloides stercoralis
         5. Ascaris lumbricoides
         6. Hookworm infection
         7. Trichuris trichiura
      4. Fungal
         1. Candida species
   2. Other infections
2. Food poisoning
3. Antibiotic-associated diarrhea
4. Allergic disorders
   1. Cow milkprotein sensitivity
   2. Soy protein sensitivity
   3. Other food allergy
5. Congenital aganglionic megacolon (Hirschsprungdisease)
6. Hemolytic-uremic syndrome
7. Intussusception

» READ BOOK EXCERPT ONLINE »

Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006

Diarrhea: Medical causes
(Nursing: Interpreting Signs and Symptoms)

Anthrax (GI).Anthrax manifests after the patient has eaten contaminated meat from an animal infected with Bacillus anthracis. Early signs and symptoms include decreased appetite, nausea, vomiting, and a fever. Later signs and symptoms include severe bloody diarrhea, abdominal pain, and hematemesis.

Carcinoid syndrome.With carcinoid syndrome, severe diarrhea occurs with flushing—usually of the head and neck—that's commonly caused by emotional stimuli or the ingestion of food, hot water, or alcohol. Associated signs and symptoms include abdominal cramps, dyspnea, weight loss, anorexia, weakness, palpitations, valvular heart disease, and depression.

Cholera.After ingesting water or food contaminated by the bacterium Vibrio cholerae, the patient experiences abrupt watery diarrhea and vomiting. Other signs and symptoms include thirst (due to severe water and electrolyte loss), weakness, muscle cramps, decreased skin turgor, oliguria, tachycardia, and hypotension. Without treatment, death can occur within hours.

Clostridium difficile infection. The patient may be asymptomatic or may have soft, unformed stools or watery diarrhea that may be foul smelling or grossly bloody; abdominal pain, cramping, and tenderness; a fever; and a white blood cell count as high as 20,000/ml. In severe cases, the patient may develop toxic megacolon, colon perforation, or peritonitis.

Crohn's disease.Crohn's disease is a recurring inflammatory disorder that produces diarrhea accompanied by abdominal pain with guarding and tenderness and nausea. The patient may also display a fever, chills, weakness, anorexia, and weight loss.

Escherichia coli O157:H7. Watery or bloody diarrhea, nausea, vomiting, fever, and abdominal cramps occur after the patient eats undercooked beef or other foods contaminated with this particular strain of bacteria. Hemolytic uremic syndrome, which causes red blood cell destruction and eventually acute renal failure, is a complication of E. coli O157:H7 in children age 5 and younger and elderly people.

Infections.Acute viral, bacterial, and protozoal infections (such as cryptosporidiosis) cause the sudden onset of watery diarrhea as well as abdominal pain, cramps, nausea, vomiting, and a fever. Significant fluid and electrolyte loss may cause signs of dehydration and shock. Chronic tuberculosis and fungal and parasitic infections may produce a less severe but more persistent diarrhea, accompanied by epigastric distress, vomiting, weight loss and, possibly, passage of blood and mucus.

Intestinal obstruction.Partial intestinal obstruction increases intestinal motility, resulting in diarrhea, abdominal pain with tenderness and guarding, nausea and, possibly, distention.

Irritable bowel syndrome (IBS).With IBS, diarrhea alternates with constipation or normal bowel function. Related findings include abdominal pain, tenderness, and distention; dyspepsia; and nausea.

Ischemic bowel disease.Ischemic bowel disease is a life-threatening disorder that causes bloody diarrhea with abdominal pain. If severe, shock may occur, requiring surgery.

Lactose intolerance.With lactose intolerance, diarrhea occurs within several hours of ingesting milk or milk products. It's accompanied by cramps, abdominal pain, borborygmi, bloating, nausea, and flatus.

Listeriosis.With listeriosis, diarrhea occurs in conjunction with a fever, myalgia, abdominal pain, nausea, and vomiting. A fever, a headache, nuchal rigidity, and an altered level of consciousness may occur if the infection spreads to the nervous system and causes meningitis.

Pseudomembranous enterocolitis.Pseudomembranous enterocolitis is a potentially life-threatening disorder that commonly follows antibiotic administration. It produces copious watery, green, foul-smelling, bloody diarrhea that rapidly precipitates signs of shock. Other signs and symptoms include colicky abdominal pain, distention, a fever, and dehydration.

Q fever.Q fever is caused by the bacterium Coxiella burnetii and causes diarrhea along with a fever, chills, a severe headache, malaise, chest pain, and vomiting. In severe cases, hepatitis or pneumonia may follow.

Rotavirus gastroenteritis.Rotavirus gastroenteritis commonly starts with a fever, nausea, and vomiting, followed by diarrhea. The illness can range from mild to severe and can last from 3 to 9 days. Diarrhea and vomiting may result in dehydration.

Thyrotoxicosis.With thyrotoxicosis, nervousness, tremors, diaphoresis, weight loss despite increased appetite, dyspnea, palpitations, tachycardia, an enlarged thyroid, heat intolerance and, possibly, exophthalmos accompany diarrhea.

Ulcerative colitis.The hallmark of ulcerative colitis is recurrent bloody diarrhea with pus or mucus. Other signs and symptoms include tenesmus, hyperactive bowel sounds, cramping lower abdominal pain, a low-grade fever, anorexia and, at times, nausea and vomiting. Weight loss, anemia, and weakness are late findings.

Other causes

Drugs.Many antibiotics—such as ampicillin, cephalosporins, tetracyclines, and clindamycin—cause diarrhea. Other drugs that may cause diarrhea include magnesium-containing antacids, colchicine, guanethidine, lactulose, dantrolene, ethacrynic acid, mefenamic acid, methotrexate, metyrosine and, in high doses, cardiac glycosides and quinidine. Laxative abuse can cause acute or chronic diarrhea.

Treatments.Gastrectomy, gastroenterostomy, and pyloroplasty may produce diarrhea. High-dose radiation therapy may produce enteritis associated with diarrhea.

» READ BOOK EXCERPT ONLINE »

Source: Nursing: Interpreting Signs and Symptoms, 2007

Food Poisoning or Foodborne Illness: Food Poisoning or Foodborne Illness - pathophysiology
(The 5-Minute Pediatric Consult)

• Bacteria (often causes secretory diarrhea):
  • Invades intestinal epithelium
  • Elaborates toxin into the GI tract
  • Elaborates toxin into food (performed toxin is ingested)
• Virus (often causes osmotic diarrhea): Invasion of subsequent lysis of intestinal epithelial cells, leaving predominantly immature cells with inadequate disaccharidase activity

Food Poisoning or Foodborne Illness - etiology

• Bacteria and/or associated toxins. Most common (in descending order):
  • Salmonella (nontyphoid)
  • Clostridium perfringens
  • Escherichia coli
  • Staphylococcus aureus
  • Campylobacter
• Viruses including calciviruses (noro and astro)
• Parasites

» READ BOOK EXCERPT ONLINE »

Source: The 5-Minute Pediatric Consult, 2008

Sympathomimetic Poisoning: Sympathomimetic Poisoning - risk factors
(The 5-Minute Pediatric Consult)

Prescription sympathomimetics, such as methylphenidate, pose some risk factor for both the recipient of the prescription as well as siblings.

Adolescents are at increased risk for using drugs of abuse.

Sympathomimetic Poisoning - pathophysiology

• Relevant pathophysiology is based on the adrenergic receptor type stimulated by the drug in question. The adrenergic receptors of relevance include alpha 1, beta 1, and beta 2 receptors.
• Ephedrine and pseudoephedrine stimulate both alpha and beta receptors:
  • Excessive cardiovascular stimulation results in symptoms qualitatively similar to those that occur with catecholamines.
  • Ephedrine and pseudoephedrine have weaker penetration of the CNS relative to drugs of abuse.
  • As a result, users may suffer from systemic
  • complications of the relatively larger doses necessary to achieve the CNS “high” of other stimulants.
• Non-elective beta adrenergic agonists
• Isoproterenol, rarely used, is the prototypical nonselective beta agonist causing the following:
  • Tachycardia, hypotension, tachydysrhythmias, myocardial ischemia and flushing due to its cardiostimulatory and vasodilatory properties
  • Commonly CNS effects of anxiety, fear, and headache occur.
• Selective beta 2 adrenergic agonists are commonly used, and these include albuterol, levalbuterol, salmeterol, terbutaline, and others.
• Common adverse effects include:
  • Tachycardia, palpitations, and tremor
  • Hypotension, often with widened pulse pressure
  • Nausea, vomiting, and sometimes diarrhea
  • Hyperglycemia and hypokalemia
  • Elevation of CPK as well as troponin, though myocardial infarction is never expected to occur in otherwise healthy children with selective beta 2 agonist exposure
  • Anxiety, fear, and headache also may occur.
• Alpha 1 selective agonists include phenylephrine and phenylpropanolamine, though the latter is no longer commercially produced in any meaningful quantity in the US.
  • Hypertension due to direct vasoconstrictive effects is the most common effect.
  • Reflex bradycardia may occur, particularly with phenylpropanolamine.
  • Headache due to elevated BP and even CVA may occur.

Sympathomimetic Poisoning - etiology

Causative agents:

• Agents with combined alpha and beta adrenergic activity: Epinephrine, norepinephrine,dopamine, ephedrine, and pseudoephedrine
• Alpha 1 adrenergic agonists: Phenylephrine, phenylpropanolamine
• Beta adrenergic agonists: Nonselective beta agonist isoproterenol
• Selective beta 1 agonists: Dobutamine
• Selective beta 2 agonists: Albuterol, salmeterol, terubutarine, ritodrine
• OTC agents: Ephedrine-containing cold medicine, ephedra, Ma Huang
• Illicit drugs: Cocaine, amphetamine, methamphetamine, MDMA (ecstasy)
• Theophylline and caffeine may cause a clinical syndrome of sympathomimetic poisoning.

» READ BOOK EXCERPT ONLINE »

Source: The 5-Minute Pediatric Consult, 2008

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