Acute diarrhea resident survival guide

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Definition

• Three or more bowel movements daily are considered to be abnormal, and the upper limit of stool weight is generally agreed to be 200 g daily.

• Acute diarrhea has a duration of less than four weeks and is usually caused by an infection.

Management

Acute Diarrhea (<4 wks)

Hx PE

Assessment of Volume Status

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Warning Signs

NO

YES

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Resolved

Unresolved

Investigations

Fecal WBC Fecal OB

Absent

Present

Non-inflammatory

Inflammatory

Symptomatic Rx

Recent antibiotics?

Resolved

Unresolved

NO

YES

Negative C-diff

Positive C-diff

Metro/Vanco

Cx of Salmonella, followed by empiric ABx

Negative Cx

Positive Cx

Check Ova/parasites

Negative

Positive

Consider scope

Rx per results

Evaluation of Volume Status by Dhaka Method

Assessment	No dehydration	Some dehydration†	Severe dehydration‡
General condition	Normal	Irritable/less active*	Lethargic/comatose§
Eyes	Normal	Sunken	—
Mucosa	Normal	Dry	—
Thirst	Normal	Thirsty	Unable to drink§
Radial pulse	Normal	Low volume*	Absent/ uncountable§
Skin turgor	Normal	Reduced	—

† Some dehydration = At least two signs, including at least one key sign (*) are present.
‡ Severe dehydration = Signs of “some dehydration” plus at least one key sign (§) are present.

References

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