Management of Acute Diarrhea in Urgent Care

Initial Assessment and Risk Stratification

The American College of Physicians recommends immediately evaluating patients with acute diarrhea for signs of severe dehydration, such as tachycardia, altered mental status, or poor perfusion, which may require IV fluids 1
The Infectious Diseases Society of America suggests evaluating patients for red flags of inflammatory diarrhea, including fever, bloody stools, severe abdominal pain, or recent antibiotic use 1
The Centers for Disease Control and Prevention recommend assessing immunocompromised status, such as HIV, chemotherapy, or immunosuppressants, in patients with acute diarrhea 1
The World Health Organization advises evaluating patients with acute diarrhea for recent travel to endemic areas or occupational food handling risks 1

The American Gastroenterological Association recommends prescribing oral rehydration solution (ORS) to replace ongoing losses in patients with mild-to-moderate watery diarrhea, with a strength of evidence rated as high 1, 2
The European Society of Clinical Microbiology and Infectious Diseases suggests that ORS contains appropriate electrolytes, including 20 mEq/L potassium, which is critical for replacing losses, with a strength of evidence rated as moderate 2
The American College of Physicians recommends continuing ORS until clinical dehydration is corrected, with a strength of evidence rated as high 1
The National Institute of Diabetes and Digestive and Kidney Diseases advises resuming an age-appropriate diet immediately after rehydration, with a strength of evidence rated as moderate 1
The American Heart Association recommends avoiding coffee, alcohol, and spicy foods in patients with acute diarrhea, with a strength of evidence rated as low 3

The American Academy of Pediatrics recommends never prescribing loperamide when bloody diarrhea is present, with a strength of evidence rated as high 1
The Infectious Diseases Society of America advises against prescribing loperamide in patients with fever, with a strength of evidence rated as high 1
The American College of Physicians recommends avoiding exceeding 16 mg/day of loperamide due to serious cardiac adverse reactions, including QT prolongation and Torsades de Pointes, with a strength of evidence rated as high 1

The American Gastroenterological Association suggests considering adding probiotics to reduce symptom severity and duration in immunocompetent adults, with a strength of evidence rated as moderate 1
The National Institute of Diabetes and Digestive and Kidney Diseases recommends considering adding ondansetron if significant nausea or vomiting prevents oral intake, with a strength of evidence rated as moderate 1
The European Society of Clinical Microbiology and Infectious Diseases advises considering adding potassium supplementation if prolonged diarrhea or signs of hypokalemia, such as weakness or arrhythmias, are present, with a strength of evidence rated as low 2

The American College of Emergency Physicians recommends discharging most patients home with ORS and loperamide prescriptions, with a strength of evidence rated as high 1
The American College of Physicians advises admitting or referring patients with severe dehydration despite oral rehydration, with a strength of evidence rated as high 1