May 30, 2018

Interviewer: What should you do if you have a case of diarrhea? We're going to find out next on The Scope.

Announcer: This is From the Frontlines, with emergency room physician Dr. Troy Madsen on The Scope.

Interviewer: Dr. Troy Madsen is an emergency room physician at University of Utah Health. Let's talk about diarrhea and what should somebody do if they start having diarrhea? Should they be taking some medication? Should they be going to see their doctor? When should they start worrying?

Dr. Madsen: So diarrhea is obviously not the most pleasant topic. It's something probably all of us have dealt with at some point or another. But it's one of those things where you kind of have to give it time. And we do occasionally have people who come to the ER who have had diarrhea for say 12 hours or so. And they're very concerned. And they don't look particularly dehydrated, they've been able to drink plenty of fluids and stay hydrated. They don't have other medical issues that would make them more likely to get really dehydrated. So those are the kind of situations where you know, you really want to give it some time to see what happens.

Are You Dehydrated?

Because most cases of diarrhea, assuming it's from some sort of a bug or maybe something you ate, are going to get better within 24 hours. Maybe they'll last two days, maybe up to three days, but even if someone comes to the ER and they said, "I've been having diarrhea for two or three days." And I look at them and it's not like their lips look really dry and their eyes look sunken or they look like they're just really dehydrated. And they're not the kind of person who has lots of medical issues that would make them more likely to get dehydrated. I say, well, not a lot of testing we really need to do here. We don't really need to test for really unusual infections. You're probably going to get better within a day and usually it does.

So if you're someone who has diarrhea I'd say, give it a couple of days. Keep drinking fluids. You can try drinking electrolyte drinks. Those might help and make a difference. You're not losing lots of electrolytes, which can be an issue. But if it's gone on for longer than that.

Have You Been Traveling, Camping, or Have a New Pet?

If you're getting beyond three days and maybe into four or five days and maybe you've been camping recently. Or you've been swimming in mountain streams or lakes or drinking from mountain streams. Or you have a new pet. Or you have a pet turtle you found out while you were traveling and you pulled it out of a stream. These unusual things that would set you up for something more serious like giardia or salmonella. Things where we start to think about unusual infections. Those would be cases to come to the ER or see your doctor and get tested for that.

Interviewer: So generally, up until about two days, if somebody came into the ER you wouldn't run many tests if they looked healthy and they weren't at high risk of something else, you just have them wait and see?

Dr. Madsen: Most likely. I mean the reality of the ER there is the dynamics of the ER where the fact that someone comes in the door they often just get testing done. But it's typically not really necessary.

Diarrhea Treatment

Interviewer: So if it was a family member you would say just wait it out for another day or so?

Dr. Madsen: I would. If a family member called me and said I've had diarrhea for a day or two I'd say wait it out. I would ask them has it been bloody diarrhea? That raises concern for me. But most of these cases people are just having kind of normal diarrhea. Just frequent bowel movements. Watery, they're not describing blood in their bowel movements. If you're seeing those sorts of things, that's going to change things a bit. But, typical diarrhea. Give it a couple of days.

Interviewer: Would you recommend taking any sort of antidiarrheal?

Dr. Madsen: If we're worried about an infection like salmonella. So those unusual cases where let's say you've had recent foreign travel or you have had recent exposure to mountain streams and you're drinking from mountain streams or swimming in lakes. There we're hesitant to say use something like Imodium. Just because people that have those infections can then become chronic carriers of the disease or it can make things worse. But in the average case of diarrhea where those are not a concern, I think Imodium is perfectly fine. I don't think there's a problem at all. If it can help you get through the day, get through work, whatever you have to do. No issues with that.

Severe Diarrhea Symptoms

Again we're talking here about the average person who doesn't have a lot of medical issues. Times where you would be more concerned about diarrhea. Even after a day or two would be . . . If you do have some medical problems that make you more prone to dehydration. Maybe you take a water pill. Something for heart failure or for kidney issues that takes water off. And then you're losing fluids because of diarrhea. Maybe you then start to feel light headed. Or you're dizzy. These would all be things where I would say where I would say yeah, you need to come to the ER. You may need some IV fluids. We may need to rehydrate you.

Also, very young children. If they are really just not taking fluids well. When they cry, they're not making tears. Their eyes look sunken. You look at their mouth, their lips look dry. Again, reasons to go to the ER even after maybe even 12 to 24 hours of diarrhea.

Interviewer: Sounds like in the common cases it's dehydration you're most worried about?

Dr. Madsen: Exactly, dehydration and then along with that electrolyte abnormalities where you can lose electrolytes with the diarrhea.

Interviewer: All right, so watch out for those things. Think about, have I done anything strange or unusual recently that might be the cause of this that could be a little bit more insidious. Otherwise just wait it out.

Dr. Madsen: Exactly, give it some time. It'll run its course. You'll probably get better within a day or two.

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updated: May 30, 2018
originally published: September 6, 2016

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