Management of Diarrhea, Heartburn, and Dizziness
The immediate priority is oral rehydration with reduced osmolarity oral rehydration solution (ORS) to address dehydration causing dizziness, followed by symptomatic management of diarrhea with loperamide (if appropriate) and treatment of heartburn with standard acid suppression. 1
Initial Assessment and Red Flags
First, assess for signs of dehydration and severity:
- Dizziness suggests volume depletion - check for orthostatic changes, decreased urination, dry mucous membranes, and tachycardia 1
- Rule out severe dehydration requiring IV fluids: altered mental status, shock, inability to tolerate oral intake 1
- Assess stool characteristics: frequency, presence of blood, fever, or severe abdominal pain 1
- Screen for alarm features: fever with diarrhea (suggests inflammatory process), bloody stools, severe abdominal pain, or signs of sepsis 1
Critical pitfall: Dizziness with diarrhea indicates at least moderate dehydration and requires aggressive rehydration, not just symptomatic treatment 1, 2
Immediate Rehydration Strategy
Reduced osmolarity ORS is first-line therapy for mild-to-moderate dehydration (containing approximately 45-75 mEq/L sodium, with glucose) 1, 2
- Administer ORS until clinical dehydration is corrected - patient should drink 8-10 large glasses of clear liquids daily 1
- Replace ongoing stool losses with additional ORS 1
- Avoid plain water, sports drinks, or juice alone - these have inadequate sodium concentration and can worsen electrolyte imbalance 2, 3
If severe dehydration is present (altered mental status, shock, persistent vomiting preventing oral intake):
- Administer isotonic IV fluids (lactated Ringer's or 0.9% normal saline) 1, 4
- Once stabilized, transition to ORS for remaining deficit replacement 1, 4
Diarrhea Management
For immunocompetent adults with watery diarrhea without fever or blood:
- Loperamide 4 mg initially, then 2 mg after each loose stool (maximum 16 mg/day) 1
- Continue until diarrhea-free for 12 hours 1
Important contraindications to loperamide:
- Do NOT use if fever is present or bloody stools (risk of toxic megacolon) 1
- Avoid in children under 18 years 1
- Stop if symptoms worsen or persist beyond 48 hours 1
Dietary modifications:
- BRAT diet (bananas, rice, applesauce, toast) 1
- Stop all lactose-containing products and alcohol 1
- Resume age-appropriate diet once rehydrated 1
Heartburn Management
While the evidence provided focuses primarily on diarrhea, standard acid suppression therapy (proton pump inhibitors or H2-receptor antagonists) should be initiated for heartburn symptoms based on general medical practice.
When to Escalate Care
Seek immediate medical attention if:
- Dizziness persists despite oral rehydration attempts 1
- Fever develops (temperature >38°C) with diarrhea 1
- Blood appears in stool 1
- Severe abdominal cramping or pain 1
- Signs of severe dehydration: confusion, inability to stand, no urination for 8+ hours 1
- Diarrhea persists beyond 48 hours on loperamide 1
Hospital admission criteria:
- Inability to maintain hydration orally 1
- Persistent severe symptoms despite outpatient management 1
- Immunocompromised status with persistent symptoms 1
Additional Considerations
Probiotics may be offered to reduce symptom severity and duration, taken for up to 12 weeks 1
Avoid empiric antibiotics unless there is high fever, bloody diarrhea, or recent international travel suggesting infectious cause 1
Monitor for medication-related causes: Recent antibiotics, antacids, or metformin can cause these symptoms 1, 5