Discharge Instructions - Diarrhea

As discussed in the Emergency Department prior to discharge, you have been diagnosed with diarrhea.  Diarrhea describes bowel movements that are runny or watery, and happen 3 or more times in a day.  Diarrhea is very common.  Most adolescents and adults have diarrhea about 4 times a year.  Just about everyone has it at some point.

Diarrhea can be caused by:

    -Viruses

    -Bacteria that live in food or water

    -Parasites, such as tiny worms that you can catch in some countries

    -Side effects from some medicines

    -Problems digesting certain types of food

    -Diseases that harm the digestive system

Here are some things you can try at home:

-Drink a lot of liquids that have water, salt, and sugar.  Good choices are water mixed with juice, flavored soda, and soup broth.  If you are drinking enough fluids, your urine will be light yellow or almost clear.

-Try to eat a little food.  Good choices are potatoes, noodles, rice, oatmeal, crackers, bananas, soup, and boiled vegetables.  Salty foods help the most.

Some people can also take a medicine called Loperamide (brand name: Imodium).  You should not take this medicine if you have a fever, bloody bowel movements, or severe belly pain.  Do not take more than the label tells you to.  Taking too much loperamide has led to serious heart problems in some people.  If you have health problems or already take other medicines, talk to your doctor or nurse before trying loperamide.

Return to the Emergency Department if you have signs of dehydration despite treatment, a dry mouth with no visible saliva, lethargy, high fever (≥40.0°C / 104.0°F), blood in your diarrhea, abdominal pain that move to one side of the abdomen, or have any other new or concerning symptoms.

Discharge Instructions - Traveler's Diarrhea

As discussed in the Emergency Department prior to discharge, you have been diagnosed with traveler’s diarrhea.  Travelers' diarrhea is runny or watery bowel movements in people who are traveling.  It is usually caused by bacteria but can also be caused by a virus or parasite.

You are more likely to get travelers' diarrhea if you travel in: Asia (except Singapore and Japan), Africa, South America, Central America, and Mexico, countries around the Mediterranean Sea, including Israel, and the Caribbean islands.

The main symptom is runny or watery bowel movements.  These usually start about 4 to 14 days after arriving.  Other symptoms can include:

    -Feeling sick

    -Loss of appetite

    -Cramps in the lower belly

    -Nausea and vomiting

    -Fever

    -Gas and bloating – Feeling like the belly is full, with pain in the middle or top of the belly.

    -Blood in the bowel movements

    -Feeling as though you need have a bowel movement even if you just did

    -Feeling you need to get to the toilet in a hurry

Travelers' diarrhea usually lasts 1 to 5 days, but some people are sick for a week or longer.

The most important treatment is getting enough fluid.  That's because diarrhea can cause the body to lose fluid.  Adults with mild diarrhea can drink lots of fluids with water, salt, and sugar.  Soup broth and water mixed with juice are good choices.  If you are drinking enough, your urine will look light yellow or almost clear.

If you have very frequent diarrhea, you can drink an "oral rehydration solution."  You can buy this in a packet at the pharmacy or as a pre-mixed solution such as Pedialyte.

You may have been prescribed an antibiotic in the Emergency Department, and if so, it is important you complete the full course – do not stop early!

You may also have been prescribed or directed to take an over-the-counter a medicine to slow down frequent bowel movements, such as Loperamide (brand name: Imodium), Diphenoxylate-Atropine (brand name: Lomotil), and Bismuth Subsalicylate (brand names: Pepto-Bismol, Kaopectate).  They can help, but they can also cause other health problems.  Bismuth salicylate might not be safe for pregnant women or people who take Aspirin for another condition.  You can take Loperamide or Diphenoxylate if you have mild diarrhea.  If you have very bad diarrhea, you should only take Loperamide or Diphenoxylate if you are also taking antibiotics.  You should stop Loperamide or Diphenoxylate if your symptoms get worse when you take them.

Return to the Emergency Department if you have signs of dehydration despite treatment, a dry mouth with no visible saliva, lethargy, high fever (≥40.0°C / 104.0°F), blood in your diarrhea, abdominal pain that move to one side of the abdomen, or have any other new or concerning symptoms.

Discharge Instructions - Gastroenteritis

As discussed in the Emergency Department prior to discharge, you have been diagnosed with [nausea/vomiting/diarrhea] that is most likely due to gastroenteritis (sometimes referred to as a ‘stomach flu’).  Gastroenteritis is an infection of the gut.  This can be caused by a bacteria or a parasite, but is most commonly caused by a virus.  Antibiotics do not work on viruses (they only work on bacteria), so there is no point in taking an antibiotic for most cases of gastroenteritis.

The most important thing for you to do is to stay hydrated.  If you or your child is vomiting, do not try to drink lots of fluid immediately after vomiting.  Wait a few hours after the vomiting has stopped and then try to drink one tablespoon of fluid.  If this causes more vomiting, wait a few more hours after the vomiting has stopped and then try again.  If it doesn’t cause more vomiting, continue hydrating yourself one tablespoon at a time every 10 minutes until you are able to tolerate more.  You may also have been prescribed a medication to treat nausea and prevent vomiting, such as Ondansetron (Zofran).  Take this medication as directed for the next 8 hours.

The fluid can be water, Pedialyte, a sports drink like Gatorade, or flat ginger-ale.  If you can keep down the fluids for a few hours without vomiting, you can try eating food.  Choose foods that are very plain, such as the B.R.A.T. diet (Bananas, Rice, Apple sauce and Toast).  You can also eat plain chicken (without the skin) and clear soups and crackers.

The vomiting usually lasts 12-24 hours, and is followed by diarrhea for several days.  If the diarrhea is very bad, you can take an over-the-counter anti-diarrheal medication for it.  It is generally thought to be a good idea to wait at least one to two days after the diarrhea starts before taking any anti-diarrheal medication.

Return to the Emergency Department if you have signs of dehydration despite treatment, a dry mouth with no visible saliva, lethargy, high fever (≥40.0°C / 104.0°F), blood in your diarrhea, abdominal pain that move to one side of the abdomen, or have any other new or concerning symptoms.