Acute Watery Diarrhea

Diarrhea is defined as the passage of three or

more loose stools in 24 hours, or defecation more
frequent than what is normal for an individual​​.
Diarrhea can be classified as:

• Acute — symptoms lasting less than 14 days;

• Persistent — symptoms lasting more than 14 days;
or
• Chronic — symptoms of more than 4 weeks
duration
• Acute diarrhea has a considerable impact on
UK morbidity. Approximately 50% of acute
diarrhea patients report absence from work or
school and around 25% of the UK population
is affected by infectious diarrhoea annually​​.
During the winter months, gastroenteritis also
carries a significant financial burden, costing
the NHS an estimated £7m to £10m per year.
• Taking an accurate history is essential when
assessing patients with diarrhoeal symptoms.
The assessment should determine the onset,
duration, frequency and severity of symptoms,
the presence of any red flags and attempt to
determine the underlying cause. It is also
important to assess patients for complications,
such as dehydration.
 why diarrhea is serious??
• If your diarrhea fails to improve and resolve
completely, you can be at risk of complications
(dehydration, electrolyte imbalance, kidney
failure and organ damage).
 Indications of admission to hospital in
patient with acute watery diarrhea
• Diarrhea lasts more than two days without
improvement.
• Excessive thirst, dry mouth or skin, little or no
urination, severe weakness, dizziness or
lightheadedness, or dark-colored urine, which
could indicate dehydration.
• Severe abdominal or rectal pain.
• Old age and immunocompromised.
• A fever of more than 102 F (39 C)
 What are the investigations for acute
?watery Diarrhoea
• A complete blood count test, measurement of
electrolytes and kidney function tests can help
indicate the severity of your diarrhea. Stool
test. Your doctor might recommend a stool
test to see if a bacterium or parasite is causing
your diarrhea.
?How do you treat acute watery Diarrhoea

• Rehydration may be done either by the oral or

intravenous routes depending upon the
degree of dehydration. Oral rehydration salt
solution of WHO formula is recommended for
oral rehydration therapy (ORT). Ringer's
lactate is the ideal intravenous fluid for
correction of severe dehydration due to
diarrhoea.
 When should I use ABOX in acute watery
diarrhea??
1.Conservative management without antibiotic
treatment is less successful for worsening
diarrhea lasting more than 3days.

2.Antibiotics may be considered in patients who

are older than 65 years, immunocompromised,
severely ill, or septic.
 ?? what ABOX to use
• Azithromycin – Azithromycin is preferred for patients
with fever or (bloody or watery diarrhea) .
Azithromycin can be given as a single 1 g dose (for
patients without dysentery) or as 500 mg once daily
for three days (for patients with or without dysentery).

• ●Fluoroquinolones – Fluoroquinolones include

ciprofloxacin (750 mg once or 500 mg twice daily for
three to five days) or levofloxacin (500 mg as a single
dose or given once daily for three to five days).
 About V.Cholerae
• tetracycline-susceptible V. cholerae, a single high
dose of doxycycline (300 mg) had similar efficacy as
a two-day course of tetracycline (500 mg every six
hours) with respect to stool output, duration of
diarrhea, vomiting, and requirement for oral
rehydration solution.
• In regions where tetracycline resistance is common,
fluoroquinolones and macrolides are alternative
agents, although resistance to fluoroquinolones has
also become common in endemic areas.
 References
Myoclinic text 2022
Cleveland test 2023
Upto date
American society of family medicine
Thank you