DIARRHEA

Question 1

MANAGEMENT

Answer 1

SEVERE DEHYDRATION
20 ml / kg IV Crystalloid

MILD / MODERATE DEHYDRATION
50-100 ml Oral Rehydration Solution over 4 hrs
AND
10 mL / kg body weight for ongoing losses
PLUS
2 mL / kg body weight for vomiting

NO DEHYDRATION
10 mL / kg body weight oral rehydration solution for ongoing losses
PLUS
2 mL / kg body weight for vomiting

ANTI-MOTILITY
Loperamide 4 mg PO x 1 dose
THEN
2 mg PO PRN

Bismuth Subsalicylate 524 mg PO x 1

ANTIEMETICS
Indications: vomiting
Ondansetron 4 mg IV / SL
Prochloperazine 5-10 mg IV / PO
Haloperidol 5 mg IV / IM / PO
Scopolamine TD behind ear

ANTI-BIOTICS
Indications:
Traveller’s Diarrhea with dehydration, > 8 stools / day, symptom duration > 1 week, immunocompromized
OR
Moderate to high suspiciion C. Diff

Contraindications:
Suspected Enterohemorrhagic E. Coli

Stool testing to r/o Shiga toxin producing E. Coli and Enterohemorrhagic E. Coli before starting antibiotics

Azithromycin:
1000 mg PO x 1
OR
500 mg PO daily x 3 days

Ciprofloxacin:
500 mg PO bid x 3-5 days

INVESTIGATIONS
Draw if ill appearing
CBC
Electrolytes
Creatinine

Stool cultures (severe dehydration, bloody diarrhea, toxicity)
C. Diff (risk factors)

Question 2

DOCUMENTATION

Answer 2

HPI
Ask about:
Character (water, mush, loose)
Colour
Frequency
Volume
Duration (< 2 weeks acute, > 4 weeks chronic)
Relation to food: osmotic decreases with fasting , secretory does not

ASSOCIATED SYMPTOMS:
abdominal pain, vomit, fever, arthritis, vision change, red eye

Inciting Factors:
Travel, recent antibiotic use, food-borne exposure, camping, poor access to unsanitary water

Question 3

DDx: ACUTE

Answer 3

Infectious

Early chronic
-IBS
-IBD
-Thyroid
-Maldigestion
-Neoplastic

Question 4

DDx: INFECTIOUS

Answer 4

Parasites
-Amoebiasis
-Giardia
Bacterial
-C. Diff
-Listeria
-Shigella
-Salmonella
-Campylobacter
Viral
-Rotavirus
-Norovirus
-Hep A