What this protocol covers
The few-days diarrhoea that reaches the counter: how to replace what is lost, when it can be slowed down and who needs to see a doctor.
1. What to ask
- Since when, and how many bowel movements a day?
- Is there blood or mucus in the stools? Do they have a fever?
- Can they drink without vomiting? Are they passing urine normally?
- Have they travelled, eaten something that may have disagreed with them, or taken antibiotics recently?
- Who is it for: a baby, a child, an older person, someone with diabetes or on diuretics?
2. Refer if any of these appear
- Blood or mucus in the stools, or a high fever.
- Signs of dehydration: hardly passing urine, dizziness on standing, a very dry mouth, in children crying without tears.
- Vomiting that stops them drinking.
- More than 2 days without improving in an adult; in babies, frail older people or people with weakened immunity, assess sooner.
- Diarrhoea with pain or fever after a recent antibiotic.
3. If there are no red flags
The essentials, always
- Replace fluids with oral rehydration solution, in sips and often.
- Sports drinks, fizzy drinks and juices do not rehydrate: too much sugar and too little salt.
- Return to normal eating as soon as they feel like it; no need to fast.
An adult with no fever or blood who needs to slow it down
- Loperamide at the leaflet dose, for 2 days at most.
- If fever or blood appears, or it does not improve, stop it and see a doctor.
What is not needed
- Antibiotics: most acute diarrhoea is viral and clears up on its own.
4. Adjust to who will take it
- Children
- Oral rehydration solution and keep eating (or breastfeeding). No loperamide unless a doctor advises it. A baby with diarrhoea and vomiting, or dry nappies, is assessed promptly.
- Older people
- They dehydrate sooner. On diuretics or blood pressure treatment, if they cannot drink, a doctor should assess them.
- Pregnancy
- Rehydration. Loperamide only on medical advice.
- Diabetes
- Watch blood glucose. If they cannot eat or drink, they should ask about their treatment: some diabetes medicines need adjusting on those days.
What not to recommend
- Loperamide with fever or blood in the stools.
- Sports drinks or fizzy drinks to rehydrate children.
- Prolonged fasting.
- Antibiotics without a prescription.
What to say at the counter. The important thing is not to get dehydrated: this solution in sips, often, and eat as soon as you feel like it. If there is blood, fever or it is no better in two days, see the doctor.
Pharmacy Pills · conveniodefarmacia.com
Patient sheet: diarrhoea
To print and hand over. It carries only what the patient needs at home.
- Drink oral rehydration solution in sips and often.
- Do not use fizzy or sports drinks to rehydrate.
- Eat normally as soon as you feel like it.
- Wash your hands well after using the toilet and before cooking.
- See your doctor if there is blood or fever, if you cannot drink, if you are hardly passing urine or if it is no better in 2 days.
Self-assessment
Three questions. When you check your answers you will see the explanation for each one.
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With fever or blood, loperamide is not advised: it could be an invasive infection.
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Oral rehydration solution has the right balance of salt and sugar; sports drinks do not.
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There is no need to fast; eating as soon as it is tolerated helps recovery.
Training content. It does not replace the summary of product characteristics or clinical judgement.