Treatment of Diarrhea with a Negative GI Panel

Initial Assessment and Management

The American Society of Clinical Oncology recommends evaluating the severity of diarrhea by assessing number of stools, stool composition, and signs of dehydration or systemic illness 3, 4
Dietary modifications should be implemented by eliminating lactose-containing products, alcohol, and high-osmolar supplements, as suggested by the Journal of Clinical Oncology [5, 6 is ignored in favor of 5]
Patients should be encouraged to consume 8-10 large glasses of clear liquids daily to prevent dehydration, according to the Journal of Clinical Oncology 5, 3
The BRAT diet, consisting of low-residue foods such as bananas, rice, applesauce, and toast, is recommended for patients with diarrhea, as suggested by the Journal of Clinical Oncology 5, 3

The Infectious Diseases Society of America recommends using reduced osmolarity oral rehydration solution as first-line therapy for mild to moderate dehydration 1, 2
For severe dehydration, shock, altered mental status, or ileus, isotonic intravenous fluids such as lactated Ringer's or normal saline should be administered, according to the Infectious Diseases Society of America 1
Intravenous rehydration should be continued until pulse, perfusion, and mental status normalize in severe cases, as recommended by the Infectious Diseases Society of America 1
Once rehydrated, ongoing losses should be replaced with oral rehydration solution until diarrhea resolves, according to the Infectious Diseases Society of America 1

The Infectious Diseases Society of America recommends that loperamide may be given to immunocompetent adults with acute watery diarrhea 1, 2
For persistent diarrhea despite loperamide treatment in adults, the National Comprehensive Cancer Network suggests considering increasing the loperamide dose or adding anticholinergic agents such as hyoscyamine or atropine 7
For severe or refractory diarrhea, octreotide may be considered, as suggested by the Journal of Clinical Oncology 5, 3

The Journal of Clinical Oncology recommends following specific grading criteria and management protocols for cancer patients with treatment-induced diarrhea and negative GI panel 4
The Infectious Diseases Society of America suggests avoiding empiric antimicrobial therapy in patients with persistent watery diarrhea lasting 14 days or more 2
Probiotics may be offered to reduce symptom severity and duration in immunocompetent adults and children, according to the Infectious Diseases Society of America 1

The Infectious Diseases Society of America recommends avoiding antimotility drugs in suspected or proven cases where toxic megacolon may result in inflammatory diarrhea or diarrhea with fever 1
Patients should be monitored for signs of dehydration or electrolyte imbalances, which require prompt intervention, as suggested by the Journal of Clinical Oncology 5, 3
Hospitalization should be considered for patients with severe dehydration, persistent grade 3-4 diarrhea, or those with complicating factors like immunosuppression, according to the Journal of Clinical Oncology 5, 3