› 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
› ! Gastroenteritis (viral and bacterial) → › ! Clostridioides difficile colitis → › Inflammatory bowel disease flare → 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
Show 33 more ▾