Acute diarrhea: A practical review

This review provides a practical, simple, and logical approach to the diagn osis and management of patients with acute infectious diarrhea, one of the most common diagnoses in clinical practice. Diarrhea in the immunocompromis ed host, traveler's diarrhea, and diarrhea in the hospitalized patient are also discussed. Most episodes of acute diarrhea are self-limited, and inves tigations should be performed only if the results will influence management and outcome. After an adequate history and physical examination, the clini cian should be able to classify the acute diarrheal illness, assess the sev erity, and determine whether investigations are needed. Most patients do no t require specific therapy. Therapy should mainly be directed at preventing dehydration. Various home remedies frequently suffice in mild, self-limite d diarrhea. However, in large-volume, dehydrating diarrhea, oral rehydratio n solutions should be used, as they are formulated to stimulate sodium and water absorption. Antidiarrheal agents can be useful in reducing the number of bowel movements and diminishing the magnitude of fluid loss. The most u seful agents are opiate derivatives and bismuth subsalicylate. Antibiotic t herapy is not required in most patients with acute diarrheal disorders. Gui delines for their use are presented. Am J Med. 1999;106:670-676. (C) 1999 b y Excerpta Medica, Inc.