What is the treatment for acute diarrhea and vomiting?

Treatment for Acute Diarrhea and Vomiting

The first-line treatment for acute diarrhea and vomiting is oral rehydration therapy with reduced osmolarity oral rehydration solution (ORS), along with early resumption of normal diet after rehydration is complete. 1

Rehydration Therapy

Mild to Moderate Dehydration

• Reduced osmolarity ORS is the first-line therapy for mild to moderate dehydration in all age groups 1
• For children: administer 50-100 mL/kg of ORS over 3-4 hours 2
• For adults: similar principles apply with volume adjusted for weight 1
• Small, frequent volumes (5-10 mL) every 1-2 minutes should be given if vomiting is present, with gradual increase as tolerated 1
• Nasogastric administration of ORS may be considered for those who cannot tolerate oral intake but have normal mental status 1

Severe Dehydration

• Isotonic intravenous fluids (lactated Ringer's or normal saline) should be administered for severe dehydration, shock, altered mental status, or ileus 1
• Continue IV rehydration until pulse, perfusion, and mental status normalize 1
• Transition to ORS once the patient is stabilized 1

Maintenance and Ongoing Loss Replacement

• After initial rehydration, provide maintenance fluids and replace ongoing losses 1
• For children: 10 mL/kg for each watery stool and 2 mL/kg for each episode of vomiting 3
• For adults: replace ongoing losses with ORS until diarrhea and vomiting resolve 1

Diet Management

• Breastfeeding should be continued throughout the diarrheal episode in infants and children 1
• Resume age-appropriate normal diet during or immediately after rehydration 1
• Early refeeding is recommended rather than withholding food 3
• Avoid restricting fluids, as adequate hydration is essential for recovery 2

Pharmacological Management

Antimotility Agents

• Loperamide may be given to immunocompetent adults with acute watery diarrhea once adequately hydrated 1
• Loperamide should NOT be given to children under 18 years with acute diarrhea 1, 3
• Avoid antimotility drugs in cases of inflammatory diarrhea, diarrhea with fever, or when toxic megacolon is suspected 1

Antiemetics

• Ondansetron may be given to children over 4 years and adults to facilitate oral rehydration when vomiting is severe 1, 4
• A single dose of ondansetron before starting ORT can significantly improve oral rehydration success rates 4

Antimicrobials

• In most cases of acute watery diarrhea without recent international travel, empiric antimicrobial therapy is NOT recommended 1
• Exceptions may be made for immunocompromised patients or ill-appearing young infants 1

Special Considerations

• Bloody diarrhea may require medical evaluation for possible antimicrobial treatment 1
• Patients with high stool output (>10 mL/kg/hour) can still benefit from ORS but may require more careful monitoring 1
• Probiotics may be considered to reduce symptom severity and duration 1

Home Management

• Early home management with ORS can reduce complications and healthcare visits 1, 5
• Families should be encouraged to keep ORS at home for prompt treatment 1
• Avoid inappropriate fluids such as apple juice, sports drinks, or sodas due to inappropriate electrolyte content and high osmolality 2

Warning Signs Requiring Medical Attention

• Inability to tolerate oral fluids 3
• Worsening signs of dehydration 3
• Development of bloody diarrhea 3
• Significant increase in fever 3

By following this evidence-based approach to managing acute diarrhea and vomiting, most patients can be successfully treated with oral rehydration therapy, avoiding complications and reducing the need for hospitalization.