Management of Diarrhea after Initial Resuscitation for Hypovolemic Shock

Fluid Management

For patients with ongoing diarrhea after initial resuscitation, continue fluid replacement with oral rehydration solution (ORS) for mild to moderate dehydration or intravenous fluids for severe dehydration until diarrhea resolves, while addressing the underlying cause 1
The Infectious Diseases Society of America recommends using reduced osmolarity oral rehydration solution (ORS) as first-line therapy for mild to moderate ongoing dehydration 1
For patients unable to tolerate oral intake, consider nasogastric administration of ORS or intravenous fluids (lactated Ringer's or normal saline) for severe dehydration 1
Maintenance fluid administration should replace ongoing stool losses with ORS until diarrhea resolves 1

If infectious colitis is suspected, obtain appropriate cultures and modify or discontinue antimicrobial treatment when a clinically plausible organism is identified 1
For C. difficile colitis, treat with enteral antibiotics (oral vancomycin preferred for severe disease) 1
Avoid antimicrobial therapy for STEC O157 and other Shiga toxin 2-producing E. coli as it may increase risk of hemolytic uremic syndrome 1
For inflammatory bowel disease or other non-infectious colitis, continue or initiate appropriate disease-specific therapy and consider early source control for any surgically remediable causes 2

Antimotility agents may be considered in adequately hydrated adults with acute watery diarrhea, but avoid in children <18 years, inflammatory diarrhea, or fever 1
Antiemetics may be given to facilitate oral rehydration tolerance in children >4 years and adolescents 1
Probiotics may reduce symptom severity and duration in immunocompetent patients 1
Zinc supplementation reduces duration of diarrhea in children 6 months to 5 years with malnutrition 1

Regularly assess vital signs, urine output, mental status, skin turgor, and mucous membrane moisture, as well as ongoing stool losses and electrolyte levels 1