If the patient is completely non-toxic and doesn’t have any red flags, they can usually go home without further testing!!!

3 Big (Non-Viral) Causes of Diarrhea

  • The Icky ‘I’s
    • Ischemia
      • Frequently require surgery consult
    • Infection
      • Frequently require antibiotics
    • Inflammatory bowel disease
      • Frequently require GI consult, steroids, or salicylates

5 Red Flags

  • Is it bloody?
    • Consider performing a guaiac test
    • Bloody diarrhea usually isn’t “just a virus”
  • Is it severely painful?
    • (Viral gastroenteritis may cause gas cramping but shouldn’t be tender or severely painful)
    • Bonus red flag!!!
      • POST-PRANDIAL pain
      • Consider mesenteric ischemia
  • Recent antibiotics or hospitalization?
    • Consider C. difficile
      • Treat with PO vancomycin
  • Recent travel?
    • ~80% travelers diarrhea is bacterial
      • Treat with ciprofloxacin
        • Note: See FDA black box for fluoroquinolones prior to prescribing
  • Do you have history of atrial fibrillation?
    • Increases risk for mesenteric ischemia and ischemic colitis

Consider Testing if Patient is Ill or has Red Flags

  • CBC
  • Electrolytes
  • Stool studies
    • Stool WBCs
    • Stool culture
    • C-diff
    • Ova/Parasite
  • CT abdomen/pelvis with IV contrast

Common Antidiarrheals

  • Loperamide (Imodium)
  • Bismuth (Pepto-Bismol)
  • Dphenoxylate (Lomotile)

Additional Reading

  • Fluoroquinolone Black Box Update (FDA)