Passage of ≥3 loose/watery stools per day; usually viral, self-limited; concern is dehydration.
History taking
- • Onset, duration, frequency, consistency, blood/mucus
- • Vomiting, fever, urine output, feeding, behaviour
- • Sick contacts, water source, recent antibiotic use
Examination
- • Weight, vitals, capillary refill, skin turgor, mucous membranes
- • Fontanelle, sunken eyes, alertness
- • Abdominal exam
Red flags
- • Severe dehydration: lethargy, sunken eyes, slow skin pinch >2 s, weak pulse
- • Blood in stool with fever, persistent vomiting
- • <2 months age, malnutrition
Differential diagnosis
- • Viral gastroenteritis (rotavirus, norovirus), bacterial (Shigella, Salmonella, EPEC), parasitic
- • Surgical: intussusception, appendicitis
- • Cow milk allergy, lactose intolerance
Recommended investigations
- • Usually clinical; stool exam if blood/mucus
- • Electrolytes, RFT if severe dehydration
Diagnosis
- • Clinical assessment of hydration (WHO categories)
Initial treatment / management
- • Plan A (no dehydration): ORS after each loose stool, continue feeding, zinc x 14 d
- • Plan B (some dehydration): 75 mL/kg ORS over 4 h, reassess
- • Plan C (severe): IV Ringer's lactate per WHO protocol
- • Antibiotics only for dysentery, cholera, immunocompromised
Prescription examples
- • ORS — 50 mL after each loose stool (<2 y), 100 mL (2–10 y), as much as desired (>10 y)
- • Tab/Syrup Zinc 10 mg/d (<6 mo) or 20 mg/d for 14 days
- • Tab Azithromycin 10 mg/kg PO OD x 3 d for dysentery
- • Avoid antimotility agents
Follow-up advice
- • Review in 24 h if dehydration; sooner if worsening
- • Persistent diarrhoea >14 d — further evaluation
Patient counselling
- • Continue feeding, breastfeed more frequently
- • ORS demonstration, danger signs: blood in stool, drowsy, unable to drink, persistent vomiting
- • Hand hygiene, safe water, rotavirus vaccination
Referral criteria
- • Severe dehydration not improving with ORS, suspected surgical cause, persistent diarrhoea
Clinical pearls
- • Zinc reduces duration and severity of diarrhoea episodes
- • Avoid antibiotics and antimotility in routine viral gastroenteritis
References
- • WHO IMCI Guidelines
- • ESPGHAN/ESPID Guidelines on Acute Gastroenteritis 2014
Educational outpatient guide — verify against local guidelines before clinical use.
