الفهرس 
Introduction
Acute gastroenteritisOnly 14 pages are availabe for public view
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Abstract
Gastroenteritis is a digestive tract infection that can be due to the viral, bacterial and parasitic pathogens, the most common symptoms include diarrhea and vomiting, which can be accompanied by fever and abdominal pain. The most common cause of acute gastroenteritis in children less than five years old is rotavirus.
Acute diarrhea is one of the principal causes of morbidity and mortality among children in low-income countries. The cornerstone of treatment is oral rehydration therapy and dietary management. Many children in developing countries die from acute diarrhea directly or through such complications such as shock, electrolyte imbalance, and sepsis.
The major complications from diarrhea from any cause are dehydration, electrolyte, or acid-base derangements, intussusception, bacteremia, hemolytic uremic syndrome (HUS), seizures or encephalopathy which can be life-threatening.
Encephalopathy is a generalized disorder of cerebral function that may be acute or chronic, progressive, or static. Clinical presentation can range from confusion, disorientation or agitation, to lethargy, obtundation and coma.
Electrolyte homeostasis in the central nervous system (CNS) is essential for brain function. Disorders of sodium and osmolality produce CNS neuronal depression, with encephalopathy as the major clinical manifestation; these disorders can also provoke CNS neuronal irritability. Hypocalcemia cause mainly CNS neuronal irritability with seizures. In contrast, disorders of potassium rarely produce symptoms in the CNS but may be associated with muscle weakness as the major clinical manifestation.
The study was done on 100 children who were admitted with encephalopathy with acute gastroenteritis at gastroenterology unit of Assiut university children hospital from 1st may 2018 to 30th April 2019 during a period of one year.
All patients were subjected to Full history included age, sex, residence, consanguinity, family history of similar condition, diarrhea (amount, frequency ,duration , consistency , bloody or not), vomiting (frequency, duration , colour , projectile or not),fever (low grade, high grade) , encephalopathy (altered mental status, irritability, coma), convulsion (type, distribution , duration, frequency, conscious level between attack), abdominal distension , abdominal pain& cramping , thirst (drink normal ,eagerly, poor or unable to drink) , urine output (normal, oliguria ,anuria).
Examination included general appearance of the patient , conscious level (alert, irritable, disturbed ), pallor, eyes (sunken or not ),vital sign (temperature, heart rate ,blood pressure, respiratory rate ),tongue (moist, dry, dry parched ), skin pinch (delayed or not) , anterior fontanel (depressed or not ) ,anthropometric measurements (weight, height, head circmference).
The investigations included complete blood count, serum electrolytes, renal function, arterial blood gases, random blood sugar, stool analysis, lumbar puncture, electroencephalography (EEG) when indicated, neuroimaging (CT) when indicated.
Most of cases were among age group less than 12 months (62%), only 38% of cases were among age group 1- 5 years. Males (55%) (35% in age group less than 12 months, 20% in age group 1-5 years) were more common than females (45%) (27% in age group less than 12 months, 18% in age group 1-5 years). Encephalopathy was more common in age group less than 12 months (62%) than in age group 1- 5 years (38%).
This study also showed that convulsions with acute gastroenteritis were more common in age group less than 12 months (22.6%) than in age group 1- 5 years (15.8%). The most common type of convulsions among infants in age group less than 12 months was generalized tonic-clonic type (78.6%) but the most common type of convulsions among children in age group 1-5years was the focal type (66.7%). Repeated convulsions were the most prevalent in both age groups (71.4% in age group less than 12 months and 66.7% in age group 1-5years). The most common duration of each attack of convulsions was within 30 seconds-2 minutes in both age groups (71.4% in age group less than 12 months and 83.3% in age group 1-5years).
The most common electrolyte disturbances that result in encephalopathy with acute gastroenteritis among infants in age group less than 12 months were hypernatremia (50%), followed by hyponatremia (46.8%), hypocalcemia (24.2%). Hypoglycemia was present in (14.5%) of cases. But the most common electrolyte disturbances that result in encephalopathy with acute gastroenteritis among children in age group 1-5 years was hyponatremia (57.9%), followed by hypernatremia (39.5%), hypocalcemia (15.8%). Hypoglycemia was present in (10.5%) of cases.
Outcome of the cases enrolled in our study was good. Most of cases survived and discharged (83.9% of infants of age group less than 12 months and 97.4% of children of age group 1-5years). Few cases died (16.1% of infants of age group less than 12 months and 2.6% of children of age group 1-5years). No neurological sequelae were observed in our survived cases.