Episode 227: Diarrhea

Emergency department management of diarrhea centers on distinguishing self-limiting cases from those requiring intervention. Most patients with acute, non-bloody diarrhea benefit from supportive care and oral rehydration rather than extensive diagnostic testing or antibiotics. Clinicians should reserve stool studies for high-risk patients, including the elderly, immunocompromised, or those with systemic symptoms like fever or severe volume depletion. Bloody stools necessitate testing for Shiga toxin, where antibiotics are contraindicated due to the risk of hemolytic uremic syndrome. For severe inflammatory diarrhea, azithromycin serves as the primary empiric treatment. However, the protozoan parasite Cyclospora represents a notable exception, requiring specific identification via GI-PCR and treatment with Bactrim, as it remains resistant to standard macrolide therapy. Senior resident Dr. Neya Vishwanath emphasizes that careful history-taking and physical examination remain the most effective tools for guiding appropriate disposition and avoiding unnecessary testing.