Blood in the Diaper

EM Clerkship

Zack Olson, MD ; Mike Estephan, MD ; Maddie Watts, MD

Health & Fitness, Science, Education, Medicine, Life Sciences

4.9 • 816 Ratings

🗓️ 13 May 2018

⏱️ 6 minutes

🔗️ Recording | iTunes | RSS

🧾️ Download transcript

Summary

The 4 Most Common Causes of Blood in Diaper

* Urinary crystals* Will be guaiac negative* Common in first few weeks of life* Vaginal bleeding* Common in newborn females as they withdraw from maternal estrogen* Maternal blood* Swallowed during birthing process* Breastfeeding with cracked/bleeding nipples* Anal fissures* Common and will improve on its own

Basic Approach

* Step 1: Check if guaiac positive* If negative, it’s not blood* Urinary crystals, food coloring, etc* Step 2: Consider vaginal bleeding* Step 3: Perform apt test* Diagnoses maternal blood* Step 4: Check for anal fissure* Self resolve* Step 5: Expand the differential diagnosis* Necrotizing enterocolitis* Intussusception* Cow’s milk allergy* Colitis* Red Food Dye

Additional Reading

* Neonate With Bloody Stool (Pediatric EM Morsels)

Transcript

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0:00.0	Hello, med students.
0:02.2	My name is Zach Olson and thank you for downloading this week's episode of the EM
0:07.4	Clerkship Podcast.
0:10.3	Let's do some peeds.
0:11.7	This is a smaller topic today.
0:14.3	Pretty straightforward, but you got to know it.
0:16.3	So let's just learn this now and be done with it.
0:19.0	This week we are talking about babies with bloody diapers.
0:24.7	The chief complaint might be GI bleed, vaginal bleeding.
0:29.2	Those are all bloody diapers.
0:30.6	Don't prematurely close, as we call it, based off of triage momentum.
0:36.4	What you need to remember today are the four common, usually benign
0:42.0	causes of bloody diapers. And those four causes are urinary crystals, vaginal bleeding, pooping,
0:51.0	swallowed maternal blood, and anal fissures. With with all of these the baby isn't going into
0:57.6	hemorrhagic shock or anything like that they are relatively straightforward in common but those are
1:03.7	the four that you need to remember urinary crystals vaginal bleeding maternal blood in the stool, and anal fissures.
1:12.7	So let's take this and turn it into a nice little protocol.
1:16.7	Baby comes into the department with, quote, blood in the diaper.
1:21.7	First step.
1:23.2	You got to test the bloody diaper for blood with a Gwaiac card because if it's negative, I think I know what's going on.
1:31.7	It's red urine crystals that look like blood.
1:36.9	Super common.
	...

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