Diarrhea

Inclusion Criteria

Dehydration, electrolyte derangement or other complication from a diarrheal illness that prevents discharge from the ED
Is not excluded based on electrolyte abnormalities set forth in other protocols
- See Hypokalemia and Hyponatremia / HypernatremiaHypernatremia
Able to tolerate PO fluids and medications
For most patient's who require CDU admission for diarrhea, obtaining a Stool Culture (PCR) is advisable - See Graphic Below
If patient has had recent antibiotics, has WBC > 15,000 or significant recent healthcare exposure, testing for C. Diff GDH and Toxin A & B is recommended

Exclusion Criteria

C. Diff infection WITH features of WBC > 20,000, sCr > 2.0 and Albumin < 2.5 or with clinical concern for toxic megacolon
Altered Mental Status
Renal Failure
Sepsis Criteria with Lactate > 2.0
sCr more than 3 times baseline
Significant electrolyte abnormalities
Inability to tolerate oral fluids or medications

The UpToDate article entitled "Approach to the adult with acute diarrhea in resource-abundant settings" is a freaking fantastic article, easily one of the best UTD articles out there. Pay special attention to the tables and figures section. Fascinating.
IV Fluids
- Bolus in main ED followed by maintenance LR in the CDU
Medication
- Antibiotics
  - Many patients sufficiently ill to require admission to CDU warrant antibiotics therapy (see table below)
  - Use stool analysis to choose the best antibiotic
  - If stool analysis non-diagnostic or not available empiric treatment with Azithromycin 1 gram one time, or 500 mg daily for three days is reasonable
  - C. Diff
    - First time - Vancomycin Oral Capsule 125 mg four times daily for 10 days
    - Recurrent Episodes - Please consult ID
- Anti Motility Agents - Use only if no fever and no blood in stool
  - Loperamide 4 mg initially and 2 mg for every loose stool thereafter, maximum 16 mg in one day.
- Antiemetics (Compazine, Phenergan, Reglan, Zofran)

Disposition

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