From the Guidelines
For acute diarrhea, patients should consult a doctor if they are frail, elderly (> 75 years), have concurrent chronic disease, or if symptoms do not abate after 48 hours, or if there is evidence of deterioration such as dehydration, abdominal distension, or the onset of dysentery 1. When considering consultation for acute diarrhea, several factors must be taken into account to ensure the best outcome in terms of morbidity, mortality, and quality of life.
Key Considerations for Consultation
- Age: The elderly (> 75 years) and children are at higher risk for complications and should be consulted sooner.
- Underlying health conditions: Patients with concurrent chronic diseases should seek medical intervention.
- Duration and severity of symptoms: If symptoms persist beyond 48 hours or worsen, medical consultation is necessary.
- Signs of deterioration: Dehydration, abdominal distension, or the onset of dysentery (fever > 38.5 °C and/or bloody stools) require immediate medical attention. For patients who do not fall into these categories and have mild symptoms, self-medication with oral loperamide can be considered as the treatment of choice, as it relieves discomfort and social dysfunction without prolonging the illness 1.
Management of Acute Diarrhea
- Self-medication is safe for otherwise healthy adults.
- Oral rehydration solutions are not necessary for adults who can maintain their fluid intake but can be beneficial in preventing dehydration.
- Probiotic agents and antimicrobial drugs are not generally recommended for self-medication except in specific cases, such as travelers under medical advice. Given the potential for severe outcomes, especially in vulnerable populations, it is crucial to prioritize medical consultation based on the factors outlined above to minimize morbidity, mortality, and improve quality of life.
From the FDA Drug Label
to contact their healthcare provider if they see blood in their stools, or if they develop a fever or abdominal distention to report to a healthcare facility if you or someone you are caring for taking loperamide hydrochloride experiences fainting episode, a rapid or irregular heartbeat or become unresponsive with acute diarrhea, that if clinical improvement is not observed in 48 hours, discontinue loperamide hydrochloride and contact their healthcare provider.
Patients with acute diarrhea should consult their healthcare provider if they experience certain symptoms, such as:
- Blood in their stools
- Fever
- Abdominal distention
- Fainting episode
- Rapid or irregular heartbeat
- Unresponsiveness If clinical improvement is not observed within 48 hours, patients should discontinue loperamide hydrochloride and contact their healthcare provider 2.
From the Research
Identification of Patients Requiring Consultation
For acute diarrhea, patients with certain symptoms or conditions should be referred to specialists for consultation. These include:
- Patients with signs of severe dehydration, bloody stools, persistent fever, or those suffering from immunodeficiencies using immunosuppressive therapy 3
- Cases of suspected nosocomial infection 3
- Patients with red flag symptoms such as blood in stool, weight loss, clinical and laboratory signs of anemia, and palpable mass in the abdomen 3, 4
Specialists for Consultation
Patients with acute diarrhea who require consultation should be referred to:
Primary Care Physicians
General practitioners or primary care physicians play a crucial role in identifying high-risk patients with acute diarrhea and referring them to specialists for urgent consultation 3, 5, 6. They should evaluate patients with acute diarrhea and provide supportive treatment, including oral rehydration and symptomatic therapy, while referring complex cases to specialists.