Guidelines for the
Management of Acute Diarrhea
Increased
incidence of acute diarrhea may occur in post-disaster situations where access
to electricity, clean water, and sanitary facilities are limited. In addition,
usual hygiene practices may be disrupted and healthcare seeking behaviors may
be altered. The following are general guidelines for healthcare providers for
the evaluation and treatment of patients presenting with acute diarrhea in
these situations. However, specific patient treatment should be determined
based on the healthcare provider’s clinical judgment. Any questions should be
directed to the local health department.
CHILDREN
Indications for medical evaluation of infants and toddlers with
acute diarrhea
∙ Young age (e.g.,
aged <6 months or weight <18 lbs.)
∙ Premature birth,
history of chronic medical conditions or concurrent illness
∙ Fever ≥38
°C (100.4 °F) for infants aged <3 months or ≥39 °C (102.2 °F) for
children aged 3—36 months
∙ Visible blood in
stool
∙ High output
diarrhea, including frequent and substantial volumes of stool
∙ Persistent
vomiting
∙ Caregiver’s
report of signs consistent with dehydration (e.g., sunken eyes or decreased
tears, dry mucous membranes, or decreased urine output)
∙ Change in mental
status (e.g., irritability, apathy, or lethargy)
∙ Suboptimal
response to oral rehydration therapy already administered or inability of the
caregiver to administer oral rehydration therapy
Principles of appropriate treatment for INFANTS AND TODDLERS with
diarrhea and dehydration
∙ Oral rehydration
solutions (ORS) such as Pedialyte ® or Gastrolyte ® or similar commercially
available solutions containing sodium, potassium and glucose should be used for
rehydration whenever patient can drink the required volumes; otherwise
appropriate intravenous fluids may be used.
∙ Oral rehydration
should be taken by patient in small, frequent volumes (spoonfuls or small
sips); see below link to table for recommended volumes and time period.
∙ For rapid
realimentation, an age-appropriate, unrestricted diet is recommended as soon as
dehydration is corrected
∙ For breastfed
infants, nursing should be continued
∙ Additional ORS
or other rehydration solutions should be administered for ongoing losses
through diarrhea
∙ No unnecessary
laboratory tests or medications should be administered
∙ The decision to
treat with antimicrobial therapy should be made on a patient-by-patient basis,
on clinical grounds, which may include
o Fever
o Bloody or
mucoid stool
o Suspicion
of sepsis
OLDER
CHILDREN AND ADULTS
Indications for medical evaluation of children > 3 years old
and adults with acute diarrhea
∙ Elderly age
∙ History of chronic
medical conditions or concurrent illness
∙ Fever ≥39
°C (102.2 °F)
∙ Visible blood in
stool
∙ High output of
diarrhea, including frequent and substantial volumes of stool
∙ Persistent
vomiting
∙ Signs consistent
with dehydration (e.g., sunken eyes or decreased tears, dry mucous membranes,
orthostatic hypotension or decreased urine output)
∙ Change in mental
status (e.g., irritability, apathy, or lethargy)
∙ Suboptimal
response to oral rehydration therapy already administered or inability to administer
oral rehydration therapy
Principles of appropriate treatment for ADULTS with diarrhea and
dehydration
∙ Oral rehydration
solutions (ORS) such as Pedialyte ® or Gastrolyte ® or similar commercially
available solutions containing sodium, potassium and glucose should be used for
rehydration whenever patient can drink the required volumes; otherwise
appropriate intravenous fluids may be used.
∙ Oral rehydration
should be taken by patient in small, frequent volumes (spoonfuls or small sips);
see below link to table for recommended volume and time period.
∙ For rapid
realimentation, unrestricted diet is recommended as soon as dehydration is
corrected
∙ Additional ORS
or other rehydration solutions should be administered for ongoing losses
through diarrhea
∙ No unnecessary
laboratory tests or medications should be administered
∙ Antimotility
agents such as Lomotil ® or Immodium ® should be considered only in patients
who are NOT febrile or having bloody/mucoid diarrhea. Antimotility agents may
reduce diarrheal output and cramps, but do not accelerate cure.
∙ The decision to
treat with antimicrobial therapy should be made on a patient-by-patient basis,
on clinical grounds, which may include
o Fever
o Bloody or
mucoid stool
o Suspicion of sepsis
This
document is also available online with a table describing the degrees of
dehydration at http://www.bt.cdc.gov/disasters/hurricanes/dguidelines.asp
