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CDC Health Advisory: Guidelines for the Management of Acute Diarrhea

This is an official CDC Health Advisory—Distributed via Health Alert Network September 5, 2005, 14:45 EDT (2:45 p.m. EDT) CDCHAN-00231-05-09-05-ADV-N

Increased incidence of acute diarrhea may occur in post-disaster situations where access to electricity, clean water, and sanitary facilities are limited. In addition, usual hygiene practices may be disrupted and healthcare seeking behaviors may be altered. The following are general guidelines for healthcare providers for the evaluation and treatment of patients presenting with acute diarrhea in these situations. However, specific patient treatment should be determined based on the healthcare provider's clinical judgment. Any questions should be directed to the local health department.

Children

Indications for Medical Evaluation of Infants and Toddlers With Acute Diarrhea

Young age (e.g., aged <6 months or weight <18 lbs.)
Premature birth, history of chronic medical conditions or concurrent illness
Fever ≥38 °C (100.4 °F) for infants aged <3 months or ≥39 °C (102.2 °F) for children aged 3–36 months
Visible blood in stool
High output diarrhea, including frequent and substantial volumes of stool
Persistent vomiting
Caregiver's report of signs consistent with dehydration (e.g., sunken eyes or decreased tears, dry mucous membranes, or decreased urine output)
Change in mental status (e.g., irritability, apathy, or lethargy)
Suboptimal response to oral rehydration therapy already administered or inability of the caregiver to administer oral rehydration therapy

Principles of Appropriate Treatment for Infants and Toddlers With Diarrhea and Dehydration

Oral rehydration solutions (ORS) such as Pedialyte (r) or Gastrolyte (r) or similar commercially available solutions containing sodium, potassium, and glucose should be used for rehydration whenever patient can drink the required volumes; otherwise appropriate intravenous fluids may be used.
Oral rehydration should be taken by patient in small, frequent volumes (spoonfuls or small sips).
For rapid realimentation, an age-appropriate, unrestricted diet is recommended as soon as dehydration is corrected.
For breast-fed infants, nursing should be continued.
Additional ORS or other rehydration solutions should be administered for ongoing losses through diarrhea.
No unnecessary laboratory tests or medications should be administered.
The decision to treat with antimicrobial therapy should be made on a patient-by-patient basis, on clinical grounds, which may include:
- Fever
- Bloody or mucoid stool
- Suspicion of sepsis

Older Children and Adults

Indications for Medical Evaluation of Children > 3 Years Old and Adults With Aacute Diarrhea

Elderly age
History of chronic medical conditions or concurrent illness
Fever ≥39 °C (102.2 °F)
Visible blood in stool
High output of diarrhea, including frequent and substantial volumes of stool

Last Updated on 5/13/2009