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Acute diarrhea is one of the most commonly reported illnesses in the United States, second only to respiratory infections. Worldwide, it is the leading cause of mortality in children younger than four years old.
An abnormal looseness of the stool, changes in stool frequency, consistency, urgency and continence.
An increased number of stools or looser form than is customary for the patient, lasting less than 2 weeks, and often associated with abdominal symptoms such as cramping, bloating, and gas. Although often mild, acute diarrhea can lead to severe dehydration as a result of large fluid and electrolyte losses.
Acute, watery diarrhea is usually caused by a virus (viral gastroenteritis.) Medications such as antibiotics and drugs that contain magnesium products are also common offenders. Recent dietary changes can also lead to acute diarrhea. These include intake of coffee, tea, colas, dietetic foods, gums or mints that contain poorly absorbable sugars. Acute bloody diarrhea suggests a bacterial cause like Campylobacter, Salmonella or Shigella. Traveling to developing areas of the world can result in exposure to bacterial pathogens common in certain areas. Eating contaminated foods such as ground beef or fresh fruit can cause diarrhea due to E.coli 0157:H7.
Most episodes of acute diarrhea resolve quickly and without antibiotic therapy with simple dietary modifications. See a doctor if your feel ill, have bloody diarrhea, severe abdominal pain or diarrhea lasting more than 48 hours.
In patients with mild acute diarrhea, no laboratory evaluation is needed because the illness generally resolves quickly. Your doctor may perform stool cultures or parasite exams if your diarrhea is severe or bloody or if you traveled to an area where infections are common.
It is important to take plenty of fluid and salt to avoid dehydration. Milk and dairy products should be avoided for 24 to 48 hours as they can make diarrhea worse. Initial dietary choices when refeeding should begin with soups and broth.
Anti-diarrheal drug therapy can be helpful to control severe symptoms, and includes bismuth subsalicylate and antimotility agents such as loperamide. These, however, should be avoided in people with high fever or bloody diarrhea and in children because the use of antidiarrheals can lead to complications of hemolytic uremic syndrome in cases of Shiga toxin E. coli (E. coli 0157:H7).
Your doctor may prescribe antibiotics if you have high fever, dysentery, or moderate to severe traveler's diarrhea.
Christina M. Surawicz, MD, FACG and Blanca Ochoa, MD, University of Washington School of Medicine, Seattle, WA
Originally published in October 2002. Updated by Christina M. Surawicz, MD, FACG in April 2007.