Acute Diarrhea

Overview

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Acute diarrhea refers to the sudden onset of loose, watery stools that last for a short period (typically less than two weeks). It is often caused by infections or reactions to food, medication, or other external factors.

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Symptoms
  • Frequent, loose, or watery stools (more than three bowel movements in a day)
  • Abdominal cramps or pain
  • Bloating or gas
  • Nausea or vomiting
  • Urgency to have a bowel movement
  • Fever (sometimes, depending on the cause)
  • Fatigue or weakness due to dehydration
Complications
  • Dehydration: The most serious complication, especially in children and the elderly. Symptoms include dry mouth, decreased urination, dizziness, and rapid heart rate.
  • Electrolyte Imbalance: Loss of essential minerals like sodium and potassium, leading to weakness, confusion, and heart issues.
  • Malnutrition: Prolonged diarrhea can lead to malabsorption of nutrients.
  • Sepsis: In rare cases, bacteria from the gastrointestinal tract can enter the bloodstream.
  • Lactose Intolerance: Post-infectious lactose intolerance may occur after an episode of acute diarrhea, especially if caused by gastrointestinal infections.
Causes

Infections

  • Viruses: Rotavirus, norovirus, and adenovirus are common viral causes.
  • Bacteria: Salmonella, Shigella, Escherichia coli (E. coli), and Campylobacter can cause bacterial gastroenteritis.
  • Parasites: Giardia lamblia and Cryptosporidium can cause parasitic infections.
  • Food Poisoning: Contaminated or improperly prepared food can introduce harmful bacteria or toxins.
  • Medication: Antibiotics, laxatives, and chemotherapy drugs can disrupt the normal gut flora, leading to diarrhea.
  • Food Intolerance: Lactose intolerance and reactions to other foods can trigger acute diarrhea.
  • Traveler’s Diarrhea: Often caused by ingesting contaminated water or food in different regions.
  • Stress and Anxiety: Emotional stress can affect gut function and cause diarrhea.
Prevention
  • Hygiene: Frequent hand washing, especially before meals and after using the restroom.
  • Safe Food Handling: Properly cooking and storing food can reduce the risk of food poisoning.
  • Clean Water: Ensure access to safe drinking water; in some areas, boiling or using water purifiers may be necessary.
  • Vaccinations: Rotavirus vaccines can prevent severe diarrhea in infants.
  • Probiotics: Taking probiotics may help restore gut balance, especially after antibiotic use.
Risk Factors
  • Age: Young children and the elderly are more susceptible.
  • Weakened Immune System: People with compromised immune systems (e.g., HIV, cancer patients) are at greater risk.
  • Recent Travel: Travelers to areas with poor sanitation may develop traveler’s diarrhea.
  • Chronic Diseases: Conditions like diabetes, inflammatory bowel disease (IBD), or irritable bowel syndrome (IBS) increase susceptibility.
  • Use of Certain Medications: Antibiotics and other medications can disrupt the balance of gut bacteria.
  • Poor Sanitation: Lack of clean water and proper hygiene facilities increases risk.
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How is it Treated?

Rehydration

  • Oral Rehydration Solutions (ORS): These solutions contain water, salts, and glucose to replace lost fluids and electrolytes.
  • Intravenous (IV) Fluids: In severe cases or for those who cannot tolerate oral fluids.

Dietary Changes

  • Clear fluids like water, broth, and ORS.
  • Gradual reintroduction of bland foods such as rice, bananas, applesauce, and toast (BRAT diet).

Medications

  • Anti-diarrheal Agents: Loperamide may help reduce the frequency of diarrhea. However, it should not be used if bacterial or parasitic infections are suspected.
  • Antibiotics: Prescribed in cases of bacterial infections (e.g., traveler's diarrhea or bacterial gastroenteritis).
  • Probiotics: Help restore the balance of good bacteria in the gut.
  • Addressing the Cause: Identifying and treating the underlying cause (e.g., stopping a medication, treating a food allergy, etc.).
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How is it Diagnosed?

Acute diarrhea is characterized by the sudden onset of three or more loose or watery stools per day, lasting less than two weeks. Diagnosis begins with a thorough history, including recent travel, food intake, medication use (e.g., antibiotics), and exposure to contaminated water or sick individuals. A physical examination evaluates signs of dehydration such as dry mucosa, poor skin turgor, hypotension, and altered mental status.

Laboratory tests are often not needed in mild cases. However, in cases with bloody stools, high fever, prolonged symptoms, or suspected outbreaks, stool studies are essential. These include stool cultures to detect bacterial pathogens (e.g., Salmonella, Shigella, E. coli), ova and parasite tests for protozoa (e.g., Giardia lamblia), and Clostridium difficile toxin assay if antibiotic-associated diarrhea is suspected. A complete blood count (CBC) may show leukocytosis in bacterial infections. Electrolyte panels help assess dehydration severity and guide fluid management.

For hospitalized or immunocompromised patients, further diagnostics may include imaging to rule out complications such as colitis or bowel perforation. Management decisions depend on etiology, hydration status, and presence of alarming symptoms.

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FAQs

Seek medical attention if diarrhea lasts more than two days, if there’s a high fever, if there’s blood in the stool, or signs of severe dehydration (e.g., no urination, dizziness).

Yes, many cases of acute diarrhea, especially those caused by infections (viral or bacterial), can be contagious. It is important to maintain good hygiene to prevent spread.

Anti-diarrheal medications like loperamide can be used, but should be avoided in cases of bacterial or parasitic infections as they may worsen the condition.

Once vomiting subsides, bland foods like rice, bananas, and toast can be introduced gradually.

Yes, stress and anxiety can stimulate the gut, leading to diarrhea.

Drinking plenty of fluids, especially ORS, water, and broth, helps maintain hydration. Avoid sugary or caffeinated drinks.

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