Diarrhea

Objectives

1. In all patients with diarrhea,
   • Determine hydration status,
   • Treat dehydration appropriately.
2. In patients with acute diarrhea, use history to establish the possible etiology (e.g., infectious contacts, travel, recent antibiotic or other medication use, common eating place for multiple ill patients).
3. In patients with acute diarrhea who have had recent hospitalization or recent antibiotic use, look for Clostridium difficile.
4. In patients with acute diarrhea, counsel about the timing of return to work/school (re: the likelihood of infectivity).
5. Pursue investigation, in a timely manner, of elderly with unexplained diarrhea, as they are more likely to have pathology.
6. In a young person with chronic or recurrent diarrhea, with no red flag symptoms or signs, use established clinical criteria to make a positive diagnosis of irritable bowel syndrome (do not overinvestigate).
7. In patients with chronic or recurrent diarrhea, look for both gastrointestinal and non-gastrointestinal symptoms and signs suggestive of specific diseases (e.g., inflammatory bowel disease, malabsorption syndromes, and compromised immune system).