Treatment of Acute Diarrheal Disease

Assessment and Rehydration

The cornerstone of treatment for acute diarrheal disease is oral rehydration therapy (ORT) using reduced osmolarity oral rehydration solution (ORS), which should be administered as first-line therapy for mild to moderate dehydration in all age groups, as recommended by the Infectious Diseases Society of America 1
Evaluate the degree of dehydration clinically by assessing skin turgor, mucous membranes, mental status, pulse, and capillary refill time, according to the Centers for Disease Control and Prevention 1, 2
Categorize dehydration as mild (3-5% fluid deficit), moderate (6-9% fluid deficit), or severe (≥10% fluid deficit, shock or near shock), based on guidelines from the Centers for Disease Control and Prevention 2
For mild dehydration (3-5% deficit), give 50 mL/kg ORS over 2-4 hours, and for moderate dehydration (6-9% deficit), give 100 mL/kg ORS over 2-4 hours, as recommended by the Centers for Disease Control and Prevention 2
Immediate intravenous rehydration with isotonic fluids (lactated Ringer's or normal saline) is required for severe dehydration, according to the Infectious Diseases Society of America 1

After rehydration, administer maintenance fluids and replace ongoing losses, as recommended by the Infectious Diseases Society of America and the Centers for Disease Control and Prevention 1, 2
Replace each watery stool with 10 mL/kg of ORS, and each episode of emesis with 2 mL/kg of ORS, according to the Centers for Disease Control and Prevention 2
Continue breastfeeding throughout the diarrheal episode in infants, and resume age-appropriate diet during or immediately after rehydration, as recommended by the Infectious Diseases Society of America and the American Academy of Pediatrics 1, 4

Loperamide may be given to immunocompetent adults with acute watery diarrhea, but avoid antimotility drugs in children under 18 years of age, as recommended by the Infectious Diseases Society of America 1
Ondansetron may be given to facilitate oral rehydration in children >4 years of age and adolescents with vomiting, but only after adequate hydration is achieved, according to the Infectious Diseases Society of America 1
Probiotic preparations may be offered to reduce symptom severity and duration in immunocompetent adults and children with infectious or antimicrobial-associated diarrhea, as recommended by the Infectious Diseases Society of America 1
Oral zinc supplementation reduces diarrhea duration in children 6 months to 5 years of age who live in countries with high zinc deficiency prevalence or who show signs of malnutrition, according to the World Health Organization and the Infectious Diseases Society of America 1