What is the treatment for diarrhea?

Treatment of Diarrhea

The primary treatment for diarrhea is oral rehydration therapy (ORT) combined with early nutritional support, which effectively manages most cases by replacing fluid losses and maintaining nutritional status. 1

Assessment of Dehydration

Assessment of hydration status is crucial for determining appropriate treatment:

• Mild dehydration (3-5% fluid deficit): increased thirst, slightly dry mucous membranes 1
• Moderate dehydration (6-9% fluid deficit): loss of skin turgor, tenting of skin when pinched, dry mucous membranes 1
• Severe dehydration (≥10% fluid deficit): severe lethargy or altered consciousness, prolonged skin tenting (>2 seconds), cool extremities, decreased capillary refill 1

Treatment Algorithm Based on Dehydration Status

1. Mild to Moderate Dehydration

• Oral rehydration solution (ORS) is the first-line treatment 1
• For mild dehydration: administer 50 mL/kg ORS over 2-4 hours 1
• For moderate dehydration: administer 100 mL/kg ORS over 2-4 hours 1
• Start with small volumes (5-10 mL) every 1-2 minutes, gradually increasing as tolerated 1
• Use a teaspoon, syringe, or medicine dropper for administration 1

2. Severe Dehydration

• Constitutes a medical emergency requiring immediate IV rehydration 1
• Administer boluses (20 mL/kg) of Ringer's lactate solution or normal saline until pulse, perfusion, and mental status normalize 1
• Once consciousness returns to normal, transition to oral rehydration 1

3. Replacement of Ongoing Losses

• Replace ongoing stool losses with 10 mL/kg ORS for each watery stool 1
• Replace vomit losses with 2 mL/kg ORS for each episode 1

Nutritional Management

• Early refeeding is essential - do not restrict food during diarrhea 1
• Breast-fed infants should continue nursing on demand 1
• Bottle-fed infants should receive full-strength, lactose-free, or lactose-reduced formulas immediately upon rehydration 1
• Older children and adults should continue age-appropriate diets 1
• Recommended foods include starches, cereals, yogurt, fruits, and vegetables 1
• Avoid foods high in simple sugars and fats 1

Pharmacological Treatment

• Antibiotics are generally not indicated for acute watery diarrhea 1

• Consider antibiotics only when:

  • Dysentery (bloody diarrhea) is present
  • Watery diarrhea persists for >5 days
  • High fever is present
  • Specific pathogens requiring treatment are identified 1

• Antimotility drugs (e.g., loperamide):

  • Should not be given to children <18 years due to risk of serious cardiac adverse reactions 1, 2
  • May be given to immunocompetent adults with acute watery diarrhea 1
  • Contraindicated when inhibition of peristalsis should be avoided (risk of ileus, megacolon) 2

Special Considerations

Managing Vomiting

• For patients with vomiting, administer small, frequent volumes of ORS (e.g., 5 mL every minute) 1
• Use a spoon or syringe with close supervision 1
• Correction of dehydration often reduces vomiting frequency 1

Home Management

• Early administration of ORS at home is recommended 1
• Parents should be instructed to seek medical attention if:
  • Child becomes irritable or lethargic
  • Urine output decreases
  • Intractable vomiting develops
  • Diarrhea persists 1

Common Pitfalls to Avoid

• Delaying rehydration - Begin ORT immediately upon onset of diarrhea 1
• Withholding food - Early refeeding is crucial for recovery and prevents nutritional consequences 1
• Administering large volumes of ORS too quickly - This can worsen vomiting; use small, frequent amounts 1
• Relying on plain water for rehydration - This can lead to electrolyte imbalances; use appropriate ORS 1
• Using antimotility agents in children - These are contraindicated in children under 18 years 1, 2

The combination of oral rehydration and early nutritional support effectively guides patients through diarrheal episodes, preventing unnecessary hospitalizations and deaths 1.