What is the best treatment for a 15-year-old girl with diarrhea for 3 days?

Management of Acute Diarrhea in a 15-Year-Old Girl

Oral rehydration therapy (ORT) with reduced osmolarity oral rehydration solution (ORS) is the first-line treatment for this adolescent with acute diarrhea of 3 days duration, along with early resumption of normal diet after rehydration is complete. 1

Assessment of Dehydration

• Evaluate the degree of dehydration by examining skin turgor, mucous membranes, mental status, pulse, and capillary refill time 2, 3
• Dehydration can be categorized as:
  • Mild (3-5% fluid deficit): Slightly dry mucous membranes, normal to slightly increased heart rate
  • Moderate (6-9% fluid deficit): Dry mucous membranes, increased heart rate, reduced skin turgor
  • Severe (≥10% fluid deficit): Marked tachycardia, significantly reduced skin turgor, altered mental status 2, 1
• Weighing the patient is essential to establish a reference point and monitor treatment effectiveness 3

Rehydration Protocol

• For mild dehydration (3-5% fluid deficit), administer 50 mL/kg of ORS over 2-4 hours 2, 1
• For moderate dehydration (6-9% fluid deficit), administer 100 mL/kg of ORS over 2-4 hours 2, 1
• For severe dehydration (≥10% fluid deficit or shock), begin with intravenous rehydration until vital signs normalize, then transition to oral therapy 2, 1
• If vomiting is present, administer small, frequent volumes (5-10 mL) of ORS every 1-2 minutes, with gradual increase as tolerated 1
• A successful ORS tolerance test involves the patient consuming at least 20-25 mL/kg of ORS in the first few hours of treatment 4

Maintenance and Ongoing Loss Replacement

• After initial rehydration, replace ongoing losses with 10 mL/kg of ORS for each watery stool and 2 mL/kg for each episode of vomiting 2
• For adolescents, offer 100-200 mL of ORS after each loose stool 2
• Encourage increased intake of regular fluids in addition to ORS 2, 1

Dietary Management

• Resume normal diet immediately after rehydration is complete 1, 5
• Do not restrict food intake during the diarrheal episode as this can worsen nutritional status 2
• Energy-rich, easily digestible foods will help maintain nutritional status 2
• There is no justification for "resting the gut" - this approach is outdated 2, 5

Pharmacological Management

• Antimotility drugs like loperamide should NOT be given to children under 18 years with acute diarrhea 1, 6
• Avoid antiemetics, antidiarrhetics, and spasmolytics as they are unnecessary and potentially risky in pediatric patients 5
• Antibiotics are not indicated for routine, uncomplicated acute watery diarrhea 5, 7
• If bloody diarrhea (dysentery) is present, medical evaluation for possible antimicrobial treatment may be needed 1

Home Management Instructions

• Reassess hydration status after 2-4 hours of rehydration 2, 3
• If dehydration persists, reassess the fluid deficit and restart rehydration 2
• Advise to return to medical care if:
  • Diarrhea worsens or persists beyond 5 days
  • Vomiting becomes persistent
  • Signs of dehydration develop or worsen
  • Fever develops or increases
  • Blood appears in the stool 2, 1

Pitfalls to Avoid

• Do not allow the adolescent to drink large volumes of ORS at once, as this may induce vomiting; instead, administer in small amounts frequently 2
• Do not use soft drinks for rehydration as they have high osmolality and are not recommended 2
• Do not delay refeeding after rehydration, as this can worsen nutritional status 2, 1
• Do not use antimotility medications in pediatric patients, as they are contraindicated under age 18 1, 6