What is the treatment for diarrhea?

Treatment of Diarrhea

The primary treatment for diarrhea is oral rehydration therapy (ORT) with appropriate fluid replacement and early reintroduction of normal diet, while antimotility agents like loperamide can be used in adults with non-bloody diarrhea. 1

Assessment of Dehydration

Proper assessment of dehydration severity is crucial for determining treatment approach:

Mild Dehydration (3-5% fluid deficit)

• Signs: Increased thirst, slightly dry mucous membranes
• Treatment: 50 mL/kg of oral rehydration solution (ORS) over 2-4 hours

Moderate Dehydration (6-9% fluid deficit)

• Signs: Loss of skin turgor, tenting of skin when pinched, dry mucous membranes
• Treatment: 100 mL/kg of ORS over 2-4 hours

Severe Dehydration (≥10% fluid deficit)

• Signs: Severe lethargy, altered consciousness, prolonged skin tenting (>2 seconds), cool extremities, decreased capillary refill
• Treatment: Immediate IV rehydration with 20 mL/kg boluses of Ringer's lactate or normal saline until circulation normalizes 1

Rehydration Protocol

1. Rehydration Phase:

   • Replace fluid deficit based on dehydration severity
   • Administer small volumes initially (e.g., one teaspoon) and gradually increase
   • Reassess hydration status after 2-4 hours

2. Maintenance Phase:

   • Continue appropriate fluid intake
   • Replace ongoing losses: 10 mL/kg for each watery stool and 2 mL/kg for each episode of vomiting
   • Reintroduce normal diet as soon as possible 1

Dietary Management

• Infants:

  • Breastfed infants should continue nursing on demand
  • Formula-fed infants should receive full-strength formula immediately upon rehydration
  • Consider lactose-free formulas if signs of lactose intolerance develop

• Children and Adults:

  • Continue regular diet as guided by appetite
  • Avoid fatty, heavy, spicy foods and caffeine
  • Consider avoiding lactose-containing foods for prolonged episodes 1

Pharmacological Treatment

Adults and Children >12 years:

• Loperamide: 2 mg after each loose stool (flexible dosing)
  • Contraindicated in bloody diarrhea, severe vomiting, or high fever
  • Avoid in children under 12 years
  • Do not exceed recommended dosage due to risk of cardiac adverse reactions 1, 2

Antimicrobials:

• Generally not indicated for routine acute watery diarrhea
• Consider for:
  • Dysentery (bloody diarrhea with fever)
  • Watery diarrhea lasting >5 days
  • Specific identified pathogens requiring treatment 1

Special Considerations

For Vomiting Patients:

• Administer ORS in small, frequent volumes (e.g., 5 mL every minute)
• Use spoon or syringe for controlled administration
• Correction of dehydration often reduces vomiting frequency 1

When to Seek Medical Care:

• No improvement within 48 hours
• Worsening symptoms
• Development of warning signs: severe vomiting, dehydration, persistent fever, abdominal distension, or blood in stools 1

Common Pitfalls to Avoid

1. Overuse of antimotility agents: Avoid in bloody diarrhea or suspected inflammatory conditions
2. Delaying refeeding: Early reintroduction of normal diet is beneficial, not harmful
3. Inadequate fluid replacement: Ongoing losses must be continuously replaced
4. Ignoring warning signs: Severe dehydration requires immediate medical attention
5. Exceeding recommended loperamide dosage: Can lead to serious cardiac adverse reactions 1, 2