Oldie but Goodie Pediatric Clinical Concepts

​A number of older clinical concepts may be unfamiliar to younger clinicians, but these clinical concepts are useful in pediatric medicine. Some of these concepts showed up in the medical literature for the first time nearly a century ago. Physicians should feel free to question the potential value and validity of older clinical concepts that aren't at the forefront of medical education, but my experience of more than 30 years practicing pediatrics and emergency medicine has repeatedly affirmed to me that these are valuable in emergency medicine.​Parenteral DiarrheaThe concept of parenteral diarrhea has been around for at least a century. (Can Med Assoc J 1922;12[8]:554; Proc R Soc Med 1944;37[9]:479; Pediatrics 1948;2[5]:525.) It is often not recognized, acknowledged, or discussed as an important clinical entity, however. This type of diarrhea is caused by infections outside the gastrointestinal tract. The pathophysiology is unclear, but infections elsewhere in the body such as otitis media or (more frequently) urinary tract infections are often associated with diarrhea.The diarrhea, however, can be characterized as different from the diarrhea patterns commonly seen with gastrointestinal diseases. Parenteral diarrhea is typically only two or three loose stools a day rather than the five to 10 watery stools seen with most cases of acute gastroenteritis. Parenteral diarrhea can also occur in concordance with occasional vomiting and fever. I have seen this patte...
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