Diarrhea


Definitions

  1. Diarrhea
  2. Dysentery
  3. Enteritis
  4. Gastritis
  5. Gastroenteritis
  6. Tenesmus

Diagnosis

Pathophysiology

General Concepts

Treatment

  1. Oral rehydration is mainstay of Tx, esp in Peds
  2. IVF if severe dehydration or vomiting
  3. Antibiotics: pt appears toxic or signs of bacterial diarrhea: 
  4. Symptomatic Tx nonbacterial benign diarrhea:
  5. Other Rx:

Disposition

  1. If tolerating PO, usually d/c home w/good f/u
  2. Admit severe dehydration, intractable vomiting, very old, very young or underlying disease

 

Admit Orders: Acute Diarrhea

1. Admit to:

2. Diagnosis: Acute Diarrhea

3. Condition:

4. Vital Signs: q6h; call physician if BP >160/90, <80/60; P >120; R>25; T >38.5°C.

5. Activity: Up ad lib

6. Nursing: Daily weights, inputs and outputs.

7. Diet: NPO except ice chips for 24h, then low residual elemental diet; no milk products.

8. IV Fluids: 1-2 L NS over 1-2 hours; then D5 ½ NS with 40 mEq KCL/L at 125 cc/h.
 

9. Special Medications:

Febrile or gross blood in stool or neutrophils on microscopic exam or prior travel:

-Ciprofloxacin (Cipro) 500 mg PO bid OR

-Levofloxacin (Levaquin) 500 mg PO qdOR

  -Trimethoprim/SMX (Bactrim DS) (160/800 mg) one DS tab PO bid.

10
Symptomatic Medications: - Morphine sulfate 5-10 mg IV push prn pain.
 - Zolpidem (Ambien) 5-10 mg qhs PO prn insomnia.
 - Zofran 4mg IV q4-6h prn
 -Acetaminophen (Tylenol) 650 mg 2 tab PO/PR q4-6h prn temp >38°C or pain.
 -Docusate sodium (Colace) 100 mg PO qhs.
 -Famotidine (Pepcid) 20 mg IV/PO q12h.
 -Heparin 5000 U SQ q12h or pneumatic compression stockings
 

11. Extras: Upright abdomen. GI consult.

12. Labs: CMP CBC with differential, UA, blood culture x 2.
1
3.Stool studies: Wright's stain for fecal leukocytes, culture for enteric pathogens, ova and parasites x 3, clostridium difficile toxin.