XStore theme
-----------------------------------------------------
-----------------------------------------------------
-----------------------------------------------------
-----------------------------------------------------
-----------------------------------------------------
-----------------------------------------------------
-----------------------------------------------------
-----------------------------------------------------
Suspected drug induced (Drug withdrawal, Medication ADR, Antibiotic induced (recent antibiotic use ( within 3 month) may lead to growth of C. difficile)?   To know more about the common drugs that might cause diarrhea, Click here
-----------------------------------------------------
-----------------------------------------------------

Determine the percentage change in weight

Formula= (Patient’s current weight - patient’s previous or normal weight)/100

  Reconfirm the value using the signs in the Chart.
Based on the signs in the Chart choose the percentage change in body weight.
-----------------------------------------------------

Determine the percentage change in weight

Formula= (Patient’s current weight - patient’s previous or normal weight)/100

  Reconfirm the value using the signs in the Chart.
Based on the signs in the Chart choose the percentage change in body weight.

Recommendation: Require medical referral

Rationale:

Require more careful investigations and lab tests.

Recommendation: Require medical referral

Rationale:
  • Indicator of Invasive Infection: High fever, especially when accompanied by other symptoms like bloody stools, can be a sign of a more serious invasive bacterial infection. In such cases, antibiotics may be necessary, and self-treatment is inappropriate.
  • Risk of Systemic Illness: High fever can also suggest the potential for or presence of systemic complications. For example, certain bacterial infections can lead to severe conditions. These situations require professional medical management.
  • Dehydration Severity: Fever can contribute to fluid loss and exacerbate dehydration, particularly in vulnerable populations like children. Severe dehydration necessitates medical intervention, including IV fluids in some cases.
  • Need for Diagnosis: A high fever often points to an underlying condition that needs accurate diagnosis to guide appropriate treatment. Self-treatment focuses on symptom relief, which may be inadequate if the root cause is not addressed.

Recommendation: Require medical referral

 
Clinical feature/ Clinical epidemiology: Within 6 hour of exposure; prominent n/v before diarrhea.   Suggested infectious pathogen: Staph aurous toxin, bacillus cereus toxin.   Rationale: Require further confirmed investigation.  
Clinical feature/ Clinical epidemiology: Exposure to chickens/turtles   Suggested infectious pathogen: Salmonella   Rationale: Require further confirmed investigation.  
Clinical feature/ Clinical epidemiology: Daycare center   Suggested infectious pathogen: Shigella, Cryptosporium, Giordia   Rationale: Require further confirmed investigation.  
Clinical feature/ Clinical epidemiology: Cruise ships   Suggested infectious pathogen: Noravirus   Rationale: Require further confirmed investigation.  
Clinical feature/ Clinical epidemiology: Recent antibiotic use, increased WBC   Suggested infectious pathogen: C. difficile   Rationale: Require further confirmed investigation.  
Clinical feature/ Clinical epidemiology: Unpasteurized dairy products   Suggested infectious pathogen: Listeria, Campylobacter, E. coli   Rationale: Require further confirmed investigation.  
Clinical feature/ Clinical epidemiology: Drinking untreated water, swimming in waters   Suggested infectious pathogen: Giardia   Rationale: Require further confirmed investigation.  
Clinical feature/ Clinical epidemiology: Severe immunocompromise   Suggested infectious pathogen: cytomegalovirus   Rationale: Require further confirmed investigation.  
Clinical feature/ Clinical epidemiology: Seafood consumption (e.g., raw oysters)   Suggested infectious pathogen: Vibrio parahemolyticus   Rationale: Require further confirmed investigation.  
Clinical feature/ Clinical epidemiology: Stools like rice water   Suggested infectious pathogen: Vibrio cholera   Rationale: Require further confirmed investigation.  
Clinical feature/ Clinical epidemiology: Traveller’s diarrhoea   Suggested infectious pathogen: Campylobacter, Nora virus, ETEC   Rationale: Require further confirmed investigation.  

Recommendation: Require medical referral

Rationale:

Blood / mucus in stool may be due to different etiology

  • Invasive Bacterial Infection: Bloody stools are often a sign of invasive bacterial infections like those caused by Shigella, Salmonella, or certain types of E. coli. as a result of damage the intestinal lining and cause bleeding
  • Inflammatory Conditions: Mucus in the stool can be a sign of inflammation in the intestinal lining, which may be due to conditions like inflammatory bowel disease (IBD) such as ulcerative colitis or Crohn's disease.
  • Other Pathologies: While less common, blood and mucus can also indicate other serious conditions that require diagnosis and specific medical or surgical management.

Recommendation: Require medical referral

Rationale:
  • Dehydration Risk: Both diarrhea and vomiting lead to significant fluid and electrolyte loss. Protracted vomiting greatly amplifies the risk of dehydration, especially in children, the elderly, and those with underlying health conditions. Self-treatment may not be adequate to manage this degree of fluid loss.
  • Oral Rehydration Limitation: The cornerstone of self-treatment for diarrhea is oral rehydration therapy (ORT). However, if someone is experiencing protracted vomiting, they may be unable to retain oral fluids, making ORT ineffective. This necessitates medical intervention, potentially including intravenous fluids.
  • Underlying Serious Conditions: It can be a symptom of various serious conditions, some of which may not be directly related to a simple gastrointestinal upset. These could include: Infections, obstructions and Other medical emergencies. In such cases, merely addressing the diarrhea with self-care is inappropriate.
  • Electrolyte Imbalance: Vomiting, in particular, can disrupt electrolyte balance, notably potassium and chloride. Severe electrolyte imbalances can have serious consequences, including cardiac arrhythmias and neurological issues. Medical monitoring and intervention may be necessary to correct these imbalances.

Recommendation: Require medical referral

Rationale:
  • Tenderness: This refers to pain or discomfort when the abdomen is touched or pressed. Severe tenderness suggests significant inflammation or irritation of the abdominal lining or internal organs. Severe abdominal pain may be a symptom of conditions such as appendicitis, intestinal obstruction, ischemic bowel, or peritonitis. It also makes it difficult to assess the patient's hydration status and their ability to tolerate oral rehydration therapy.
  • Distention: This refers to a noticeable swelling or bloating of the abdomen. Severe distention can indicate a blockage in the intestine, accumulation of fluid, or other serious issues.

Recommendation: Require medical referral

Rationale:
  • Diabetes mellitus, severe cardiovascular or renal diseases, multiple chronic medical conditions: Patients with these conditions have a reduced ability to compensate for the fluid and electrolyte losses caused by diarrhea. Diarrhea can exacerbate their existing conditions and lead to serious complications.
  • Immunocompromised patients (e.g., cancer chemotherapy, organ transplant recipients, AIDS): These patients have weakened immune systems, making them more susceptible to severe infections and complications from diarrhea.
  • Self-treatment may not be sufficient to address the underlying infection, and they may require specific antimicrobial therapy or other medical interventions.

Recommendation: Require medical referral

Rationale:
  • Physiological Changes: Pregnancy involves significant hormonal and physiological changes that can affect the gastrointestinal system. These changes can alter how the body handles fluid and electrolytes, making pregnant women potentially more vulnerable to complications from diarrhea.
  • Dehydration Risks: Dehydration poses risks to both the pregnant woman and the developing fetus. Severe dehydration can reduce blood flow to the uterus, potentially affecting fetal health.
  • Medication Concerns: The use of antidiarrheal medications needs careful consideration during pregnancy. Some medications may not be safe for the developing fetus, and it's essential to weigh the risks and benefits under a healthcare provider's supervision.
  • Underlying Conditions: Diarrhea in pregnancy could be a symptom of an underlying condition that requires specific medical management. It's crucial to rule out any serious causes and ensure appropriate care.

Recommendation: Avoid the medication and restart after 24-48 hours. If for chronic disease, medical referral.

Rationale:
  • Medication sick day rules : If a person is experiencing vomiting and diarrhea whilst taking certain medicines, they should be advised to stop the medication and re-start once well (after 24 to 48 hours of eating and drinking normally) to avoid aggravating dehydration which may lead to potential kidney damage.
    • Medicines include: ACE inhibitors, angiotensin II receptor blockers, non-steroidal anti-inflammatory drugs, diuretics and metformin.
    • Management
      • Identify the offending medication.
      • Assess the severity of the diarrhea.
      • Determine if the medication can be stopped or changed.
  • Recent antibiotic use ( within 3 month) may lead to growth of C. difficile which can be severe and requires specific antibiotic treatment (e.g., vancomycin or metronidazole).
  • This should be carefully evaluated by the physician

Recommendation: Require medical referral

Rationale:

Infants < 6 months are referred because

  • Increased vulnerability to dehydration: Infants, especially those under 6 months, have a higher proportion of body water and immature kidneys, making them more susceptible to rapid dehydration and electrolyte imbalances from diarrhea.
  • Difficulty in accurate assessment: Assessing the degree of dehydration in very young infants can be more challenging for caregivers compared to older children or adults. Subtle signs of dehydration might be missed, leading to delayed or inadequate intervention.
  • Higher risk of serious illness: Infants in this age group are at a higher risk of severe infections and complications from diarrhea, which may require prompt medical attention and specific treatments that are not suitable for self-administration.
  • Limitations of self-treatment: Self-treatment options, primarily oral rehydration therapy, might not always be sufficient to manage diarrhea in very young infants, and intravenous fluids or other medical interventions may be necessary.

Recommendation: Require medical referral

Rationale:

Older adult patients (>65 years) is a risk factor for complicated cases of Salmonella gastroenteritis, where antibiotic therapy is indicated. Also, one of the exclusion criteria for self-treatment is the "risk of significant complications (e.g., diabetes, cardiovascular disease, renal disease, immunosuppression)". Since elderly patients are more likely to have such underlying conditions, they would more often fall into the exclusion criteria

Recommendation: Require medical referral

Rationale:

Low weight patients should be evaluated by a medical professional for several reasons.

  • Dehydration Risk: Young children, and especially those with low body weight, have a higher proportion of water in their bodies. This makes them more vulnerable to rapid and severe dehydration when they lose fluids through diarrhea.
  • Even a small amount of fluid loss can be a larger percentage of their total body water, leading to more significant consequences.
  • Assessment Challenges : t can be harder to accurately assess the degree of dehydration in very small children. Subtle signs may be missed by caregivers.
  • Metabolic Concerns: Children with low weight may have less physiological reserve to handle the stress of diarrhea. This can affect their blood sugar levels, electrolyte balance, and overall stability.

Recommendation: Require medical referral

Rationale:
  • Compromised Physiology: Severe dehydration indicates that the body has lost a significant amount of fluid and electrolytes. This disrupts normal bodily functions, affecting:
    • Circulation: Reduced blood volume can lead to poor blood flow to organs.
    • Kidney function: Dehydration can impair the kidneys' ability to regulate fluid and electrolyte balance.
    • Neurological function: Severe fluid loss can affect brain function.
  • Ineffectiveness of Self-Treatment:
    • Oral rehydration therapy (ORT), the cornerstone of self-treatment, may not be sufficient in cases of severe dehydration.
    • The patient may be unable to drink enough fluids to replace the losses, or they may be vomiting so much that they can't keep down oral fluids.
  • Need for Urgent Intervention: Severe dehydration is a medical emergency that requires prompt intervention.
    • Intravenous (IV) fluids are often necessary to rapidly restore fluid volume and electrolyte balance.
    • Medical monitoring is crucial to assess the patient's response to treatment and prevent complications.
    • Potential for Complications: If left untreated, severe dehydration can lead to serious complications such as: Shock, Kidney failure, Seizures, Death

Recommendation: Pharmacological and non-pharmacological therapy

Non-Pharmacological

  • Dietary adjustments
    • Eat as normally as possible. Ideally include fruit juices and soups, which will provide sugar and salt, and also foods that are high in carbohydrate, such as bread, pasta, potatoes, or rice. There is little evidence to support the need to avoid solid food for 24 hours.
    • Bland Foods: The "BRAT" diet (Bananas, Rice, Applesauce, Toast) is classic. These are easy to digest.
    • Avoid spicy, fatty, fried foods, foods rich in simple sugars (e.g., carbonated soft drinks, juice, gelatin deserts), and caffeine-containing beverages, which irritate the GI tract or promote fluid secretion and may worsen diarrhea.
    • Probiotics: Yogurt (plain, unsweetened) can help restore gut bacteria.
    • Limit dairy (if it worsens symptoms).
    • Avoid caffeine or alcohol.
    • For child: If the child is hungry, then simple, plain food can be offered. Breast-fed and bottle-fed babies should continue to feed normally and the feed should not be diluted.
  • Soothing Remedies
    • Ginger: Ginger tea can calm the stomach. It has anti-inflammatory effects.
    • Chamomile Tea: May help with cramps and discomfort.
    • Rice Water: The starchy water left after cooking rice can be soothing.
  • Always wash your hands after going to the toilet (or changing nappies). Regular cleaning of the toilet, including the flush handle and toilet seat is advisable.
 

Pharmacological

 
  • ORS
    • Administer usual dietary fluids or ORS to replace ongoing losses.
    • Replace ongoing stool & emesis losses of body fluid/electrolytes, giving 10 ml/kg for each loose stool.
    • For every vomiting, replace with 5 ml/kg
  • Medication: Initiate symptomatic drug therapy with loperamide or BSS
    • Loperamide: It should only be used where symptom control is necessary and should not be used routinely for diarrhea.
      • Dosage:
        • 6-8 yrs: <4mg/day; 9-11 yrs: <6mg/day; Adults: < 8mg/day
        • two capsules should be taken after each stool (max 8 capsules in one day for max 2 days).
        • It should only be used where symptom control is necessary and should not be used routinely for diarrhea.
      • CI: <6 years; febrile patients, bloody diarrhea (to avoid super infection)
      • A/E: occasional (dizziness, constipation); rare (abd pain, distension, N/V, dry mouth, fatigue, hypersensitivity)
      • Discontinue: If abd distension, constipation and ileus occurs,
      • Drug interaction: concurrent use with H2RAs, macrolide antibiotics, antifungals and ritonavir increase CV risk
      • Pregnancy category C
    • BSS: Preferred when vomiting is predominant symptom
      • Dosage: 525 mg every 30-60 min up to 4200mg/day (8 doses/day, max 2 days)
      • A/E: harmless black staining of stool, darkening of tongue (removed by brushing)
      • CI: Allergic to aspirin, <12 years, salicylate intolerant, using other salicylate product, Pregnant and breastfeeding, pt. with bleeding risk, with antibiotics (tetracycline and fluoroquinolone), AIDs, viral infection
      • Discontinue: if tinnitus occurs and medical advice warranted
 

If diarrhea doesn’t disappear within 48-72 hours, visit physician

Recommendation: Pharmacological and non-pharmacological therapy

Non-Pharmacological

  • Dietary adjustments
    • Eat as normally as possible. Ideally include fruit juices and soups, which will provide sugar and salt, and also foods that are high in carbohydrate, such as bread, pasta, potatoes, or rice. There is little evidence to support the need to avoid solid food for 24 hours.
    • Bland Foods: The "BRAT" diet (Bananas, Rice, Applesauce, Toast) is classic. These are easy to digest.
    • Avoid spicy, fatty, fried foods, foods rich in simple sugars (e.g., carbonated soft drinks, juice, gelatin deserts), and caffeine-containing beverages, which irritate the GI tract or promote fluid secretion and may worsen diarrhea.
    • Probiotics: Yogurt (plain, unsweetened) can help restore gut bacteria.
    • Limit dairy (if it worsens symptoms).
    • Avoid caffeine or alcohol.
    • For child: If the child is hungry, then simple, plain food can be offered. Breast-fed and bottle-fed babies should continue to feed normally and the feed should not be diluted.
  • Soothing Remedies
    • Ginger: Ginger tea can calm the stomach. It has anti-inflammatory effects.
    • Chamomile Tea: May help with cramps and discomfort.
    • Rice Water: The starchy water left after cooking rice can be soothing.
  • Always wash your hands after going to the toilet (or changing nappies). Regular cleaning of the toilet, including the flush handle and toilet seat is advisable.
 

Pharmacological

 
  • ORS
      • Replacement: Begin ORT at 2-4 L over 3 hours
      • Maintenance: Replace ongoing losses of body fluid/electrolytes with 10 ml per kg after each loose stool.
      • For every vomiting, replace with 5 ml/kg
  • Medication: Initiate symptomatic drug therapy with loperamide or BSS
    • Loperamide: It should only be used where symptom control is necessary and should not be used routinely for diarrhea.
      • Dosage:
        • 6-8 yrs: <4mg/day; 9-11 yrs: <6mg/day; Adults: < 8mg/day
        • two capsules should be taken after each stool (max 8 capsules in one day for max 2 days).
      • CI: <6 years; febrile patients, bloody diarrhea (to avoid super infection)
      • A/E: occasional (dizziness, constipation); rare (abd pain, distension, N/V, dry mouth, fatigue, hypersensitivity)
      • Discontinue: If abd distension, constipation and ileus occurs,
      • Drug interaction: concurrent use with H2RAs, macrolide antibiotics, antifungals and ritonavir increase CV risk
      • Pregnancy category C
    • BSS: Preferred when vomiting is predominant symptom
      • Dosage: 525 mg every 30-60 min up to 4200mg/day (8 doses/day, max 2 days)
      • A/E: harmless black staining of stool, darkening of tongue (removed by brushing)
      • CI: Allergic to aspirin, <12 years, salicylate intolerant, using other salicylate product, Pregnant and breastfeeding, pt. with bleeding risk, with antibiotics (tetracycline and fluoroquinolone), AIDs, viral infection
      • Discontinue: if tinnitus occurs and medical advice warranted.
 

If diarrhea doesn’t disappear within 48-72 hours, visit physician

Recommendation: Pharmacological and non-pharmacological therapy

Non-Pharmacological

  • Dietary adjustments
    • Eat as normally as possible. Ideally include fruit juices and soups, which will provide sugar and salt, and also foods that are high in carbohydrate, such as bread, pasta, potatoes, or rice. There is little evidence to support the need to avoid solid food for 24 hours.
    • Bland Foods: The "BRAT" diet (Bananas, Rice, Applesauce, Toast) is classic. These are easy to digest.
    • Avoid spicy, fatty, fried foods, foods rich in simple sugars (e.g., carbonated soft drinks, juice, gelatin deserts), and caffeine-containing beverages, which irritate the GI tract or promote fluid secretion and may worsen diarrhea.
    • Probiotics: Yogurt (plain, unsweetened) can help restore gut bacteria.
    • Limit dairy (if it worsens symptoms).
    • Avoid caffeine or alcohol.
    • For child: If the child is hungry, then simple, plain food can be offered. Breast-fed and bottle-fed babies should continue to feed normally and the feed should not be diluted.
  • Soothing Remedies
    • Ginger: Ginger tea can calm the stomach. It has anti-inflammatory effects.
    • Chamomile Tea: May help with cramps and discomfort.
    • Rice Water: The starchy water left after cooking rice can be soothing.
  • Always wash your hands after going to the toilet (or changing nappies). Regular cleaning of the toilet, including the flush handle and toilet seat is advisable.
 

Pharmacological

 
  • ORS
    • Continue regular diet (guidelines states withholding food for no longer than 24 hours after patient is rehydrated.)
    • Consider adding ORS to replace ongoing stool losses, or increase intake of usual dietary fluids

If diarrhea doesn’t disappear within 48-72 hours, visit physician

Recommendation: Pharmacological and non-pharmacological therapy

Non-Pharmacological

  • Dietary adjustments
    • Eat as normally as possible. Ideally include fruit juices and soups, which will provide sugar and salt, and also foods that are high in carbohydrate, such as bread, pasta, potatoes, or rice. There is little evidence to support the need to avoid solid food for 24 hours.
    • Bland Foods: The "BRAT" diet (Bananas, Rice, Applesauce, Toast) is classic. These are easy to digest.
    • Avoid spicy, fatty, fried foods, foods rich in simple sugars (e.g., carbonated soft drinks, juice, gelatin deserts), and caffeine-containing beverages, which irritate the GI tract or promote fluid secretion and may worsen diarrhea.
    • Probiotics: Yogurt (plain, unsweetened) can help restore gut bacteria.
    • Limit dairy (if it worsens symptoms).
    • Avoid caffeine or alcohol.
    • For child: If the child is hungry, then simple, plain food can be offered. Breast-fed and bottle-fed babies should continue to feed normally and the feed should not be diluted.
  • Soothing Remedies
    • Ginger: Ginger tea can calm the stomach. It has anti-inflammatory effects.
    • Chamomile Tea: May help with cramps and discomfort.
    • Rice Water: The starchy water left after cooking rice can be soothing.
  • Always wash your hands after going to the toilet (or changing nappies). Regular cleaning of the toilet, including the flush handle and toilet seat is advisable.
 

Pharmacological

 
  • ORS
    • Replacement: Begin ORT 50-100 ml/kg over 3-4 hours.
    • Maintainance: Replace ongoing stool & emesis losses of body fluid/electrolytes, giving 10 ml/kg for each loose stool.
    • For every vomiting, replace with 5 ml/kg
 

If diarrhea doesn’t disappear within 48-72 hours, visit physician

Home
Custom
Custom
More
More

NEPHA

A must need supportive tool for the pharmacists

Legal & Compliance

Text & Conditions

Privacy Policy

Disclaimer

Contact

Email: 

Phone number: 

About

This is a mobile application specifically designed for pharmacists to assist in making informed decision. 

Know more about us

Copyright © 2025 NEPHA. All rights reserved.