Diarrhea generates a wide range of diagnostic considerations and has profound individual and public health significance. The setting and circumstances under which a patient presents with diarrhea drastically influences the concern brought to the encounter. Nausea, vomiting, and diarrhea are often provisionally labeled “gastroenteritis” with appropriate expectant management. In resource-poor countries, the significance of diarrhea is even greater. This review focuses on diarrhea and its initial evaluation and management in the emergency department.
Key points
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A thorough history and examination to evaluate for dehydration or risk for treatment failure should drive the initial management of a diarrheal illness.
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Practitioners can provide valuable education for patients and caregivers regarding symptomatic care and expected course of their illness.
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Antibiotics are associated with hemolytic–uremic syndrome and should be used cautiously in patients presenting with bloody diarrhea and no fever.
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Notification of public health authorities is recommended if diarrheal illness is suspected from cholera, enterohemorrhagic Escherichia coli , listeria , salmonella , shigella , or norovirus.
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The initial emergency evaluation of chronic diarrhea should focus on stabilization with further testing coordinated with the patient’s ongoing care provider.
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