›Critical patient workflow
›Monitor
›Continuous pulse oximetry for unstable patients
›Cardiac monitor for severe dehydration or electrolyte concern
›Access
›IV access for moderate to severe dehydration
›Two large bore IV for shock or GI bleed concern
›Fluids
›Isotonic crystalloid bolus 10 to 20 mL per kg for shock physiology
›Reassess after each bolus with vitals and perfusion
›Labs timing targets
›Electrolytes within 60 minutes for severe symptoms
›Lactate early for sepsis concern
Rehydration and electrolyte management
›Volume repletion
›Oral rehydration solution for mild dehydration
›IV isotonic fluids for moderate to severe dehydration
›Antiemetic support for oral tolerance
›Electrolyte repletion
›Potassium repletion if low
›Magnesium repletion if low
›ECG monitoring when significant hypokalemia
›Antiemetics
›Ondansetron ODT 4 mg once
›Repeat 4 mg after 8 hours as needed
›Antidiarrheals
›Loperamide 4 mg once then 2 mg after each loose stool
›Maximum 16 mg per day
›Avoid if bloody diarrhea
›Avoid if high fever
›Analgesia
›Acetaminophen 650 mg every 6 hours as needed
›Avoid NSAIDs if dehydration or AKI concern
Antimicrobials when indicated
›Targeted antibiotic principles
›Avoid empiric antibiotics for most mild watery diarrhea
›Consider empiric antibiotics for severe traveler diarrhea local protocol dependent
›Avoid antibiotics when STEC suspected
›STEC clues
›Bloody diarrhea with minimal fever
›Severe abdominal cramps
›C difficile treatment triggers
›Positive testing with compatible syndrome
›Initial episode example therapy local protocol dependent
›Fidaxomicin 200 mg PO twice daily for 10 days
›Vancomycin 125 mg PO four times daily for 10 days
›Test selection logic
›Stool testing for severe disease
›Stool testing for dysentery
›Stool testing for immunocompromised
›Minimal testing for mild self limited syndrome
›Reassessment timing
›Repeat vitals after fluids
›Repeat orthostatics when stable
›Recheck electrolytes after significant repletion
›Escalate if persistent tachycardia or hypotension