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Home | Articles | Infectious Diseases | Acute Diarrhoea

Acute Diarrhoea

Last updated 19th October 2022

Definition

  1. Loose stools more than 3 times daily, lasting less than 14 days

Causes of Infective Diarrhoea

  1. Viruses are the most common infectious causes in the community esp norovirus
  2. Bacterial causes include salmonella, campylobacter, shigella, E. coli and
  3. Click here for page on C. difficile
  4. Parasitic causes include cryptosporidium, giardia and amoebiasis

Other causes acute diarrhoea

  1. Drugs – commonly seen following docetaxel, paclitaxel, gemcitabine, capecitabine, 5FU chemo but also antibiotics, metformin, PPIs, NSAIDs
  2. First presentation IBD
  3. Acute diverticulitis
  4. Fecal impaction with overflow
  5. Surgical abdomen eg acute appendicitis
  6. Don’t forget some Covid-19 cases present with GI symptoms.

Complications Infective Diarrhoea

  1. Dehydration
  2. Acute kidney injury – particularly common when diarrhoea occurs in patient taking ACDEI/ARB
  3. HUS – a specific complication of E. coli 0157 infection, particularly if given antibiotics
  4. Toxic megacolon leading to bowel perforation – the most severe manifestation of C. diff diarrhoea

Assessment

  1. Document frequency and severity of diarrhoea and whether blood in stool
  2. Check for associated symptoms esp fever, abdo pain, nausea and vomiting
  3. Enquire if others affected, foreign travel, eating out, food past sell by date, recent antibiotics, hospital admission, contact with animals eg risk of salmonella with poultry
  4. Any new drugs? See list above and ask about OTC medications.
  5. Abdo examination including PR – will exclude faecal impaction and may be best chance of obtaining a stool sample

Stool Sample

  1. Faecal smear of 1ml is minimum required
  2. If parasitic infection suspected test for ova, cysts and parasites by sending three 5ml specimens 2-3 days apart (due to life cycle patterns of parasites)
  3. Urine should not be mixed with sample.

Red Flags for Admission

  1. Duration >4 days
  2. Bloody diarrhoea
  3. Fever
  4. Immunocompromised
  5. Unable to replace fluid losses orally
  6. Unable to self care

Management

  1. Consider whether for admission or ambulatory care – link to ambulatory care pathway
  2. Fluid replacement. Consider 1-2 litres Hartmanns over 1-2 hours if dehydrated. May require K replacement.
  3. Consider antibiotic if severe disease, bloody diarrhoea or immunocompromised.  Avoid antibiotic in E. coli as may trigger HUS.  Choice of antibiotic should be ciprofloxacin or clarithromycin unless C. diff likely in which case choose metronidazole or oral vancomycin – see HPS guidance for dosing.
  4. Anti-emetics not usually recommended but consider metoclopramide if vomiting severe.
  5. Anti motility drugs not usually indicated and are contraindicated if blood or mucus present or suspected E. coli 0157. If indicated then loperamide may be useful
  6. Review medications and stop drugs that may be causing diarrhoea.
  7. Consider withholding diuretic, ACEI and ARB if U&E suggest AKI
  8. Infection control measures – pay particular attention to hand hygiene.
  9. Provide patient with advice on preventing spread of infection to others.  Click here for Information Leaflet.

Flowchart for Management of Acute Diarrhoea

Acute diverticulitis

  1. Abdominal pain is the most common complaint in patients. The pain is usually in the left lower quadrant due to involvement of the sigmoid colon.
  2. Acute diverticulitis may be associated with a change in bowel habits, with constipation reported in approximately 50% patients and diarrhea in 25-35% patients
  3. The diagnosis is usually confirmed by CT abdo/pelvis, which also distinguishes complicated from uncomplicated disease.
  4. Complications include abscess, obstruction, perforation, fistula
  5. Inpatient management of acute diverticulitis – IV Amoxicillin, Gentamicin & Metronidazole as per empirical guideline until pain and tenderness resolve, review daily and switch to oral once patient improves.  Do not continue gentamicin beyond 3 days if possible, review and switch to alternative if IV still indicated.

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