Acute Infectious

Diarrhea
Case Presentation
Aquino, Francis B.
SOM - III
March 2020
DEMOGRAPHICS

C.M. 29 /F
Single
Sta. Maria
Dishwasher
christian
Catholic
 CHIEF COMPLAINT

Loose Bowel Movement

 HISTORY OF PRESENT ILLNESS

4 DAYS PTA 
Loose bowel
movement:
• watery, non-
1 DAY PTA
bloody, non- Loperamide • Persistence of
mucoid but offered
loose bowel
no relief
movement
• Vomiting
• Fever
• Abdominal HOURS
PTA
pain
Persistence
of
symptoms
 PAST MEDICAL HISTORY
No previous admission or surgeries
No known co morbids,
No known allergies to food and drugs,
no maintenance medications

FAMILY HISTORY
No known heredofamilial diseases
PERSONAL AND SOCIAL HISTORY

• Non-smoker, non-
alcoholic
• Dishwasher at a
university canteen
• Tap water with no
purification method.
• Diet consists of rice and
christian
vegetables
REVIEW OF SYSTEMS
(+) General Weakness

(-) Drowsiness

(-) Dyspnea

(-) Hematemesis

(-) Loss of appetite,

(-) Pain with defecation,

(-) Rectal bleeding

 PHYSICAL EXAM FINDINGS
BP: 90/60 mmHg
PR: 105 bpm
RR: 21 cpm
Temp: 36.2 C
SpO2: 97% Sunken Eyeballs

Weak-Looking Dry oral mucosa

 CLINICAL
IMPRESSION
Acute Infectious Diarrhea
with Moderate
Dehydration; Intestinal
Amoebiasis
 Basis for Acute Infectious
Diarrhea

Diarrhea (+) Abnormally liquid or unformed stools

(+) increased frequency of stools
(+) >200g/day of stools
Acute Diarrhea < 2 weeks from onset
Infectious Diarrhea (+) Vomiting
(+) Fever
(+) abdominal Pain
Most Common Causes of Infectious
Diarrhea
 Moderate Dehydration

Parameters Moderate dehydration

Fatigue +
Thirst +
Sunken eyes +
Blood pressure Orthostatic hypotension
Respiratory rate (breaths per minute) 21 - 25
Pulse rate (beats per minute)a ≥100
Peripheral circulation Cold, clammy skin
Level of consciousness Lethargic
 Moderate Dehydration

Oral mucosa Dry

Muscle weakness Mild to moderate
Skin turgor >2 seconds
Capillary refill time >2 seconds
Urine output (ml/kg/hr) <0.5
 BASIS FOR IMPRESSION
History Physical Exam
Loose bowel movement Respiratory rate: 21 bpm
Undocumented fever Blood pressure: 90/60 mmHg
Vomiting Pulse Rate: 105 bpm
Abdominal pain Sunken eyeballs
Fatigue Dry buccal mucosa
Less than 2 weeks of LBM Weak-Looking
Watery, Non Bloody, Non
Mucoid Stools
christian
 DDx
ACUTE NON-INFECTIOUS DIARRHEA PROBABLY

ddx
SECONDARY TO LACTOSE INTOLERANCE WITH
MODERATE DEHYDRATION
PARACLINICALS
 PARACLINICALS

Fecalysis
Physical
Color: Brown
Consistency: Watery
Microscopic
Pus Cells 5-11/HPF
RBC 2-5/HPF
Entamoeba histolytica Cyst/ E. Dispar 0-2/HPF
Entamoeba histolytica Trophozoite/ E. Dispar 0-1/HPF
COURSE IN THE WARD
FIRST HOSPITAL DAY
S O A P
• 3 days pta: Vital signs: Acute • Admission
Noted onset of 7-8 episodes BP: 90/60 mmHg Gastroenteri • Rehydration with 1L
of loose bowel movement, RR: 21 cpms tis with PNSS to run for 1 hour
non-mucoid, non-bloody, T: 36. 2 Moderate • Soft diet
amounting to about ½ cup P: 71 bpm Dehydration • Diagnostics
per episode. No consult O2 sat: 95% sec. to CBC, Creatinine, Sodium,
done. Self-medicated with Awake, not in Amoebiasis Potassium
loperamide respiratory distress Stool exam
• 1 day pta, persistence of (+) Sunken eyeballs Stool Culture
LBM, now with abdominal (+) Dry oral mucosa • Treatment:
pain and undocumented Metronidazole 500 mg IV q8
fever. Metoclopramide 10 mg IV
• No comorbidities HNBB 10 mg IV q8 for pain
Diloxauide Furoate 500mg
tab TID
SECOND HOSPITAL DAY
S O A P
Patient still complains Vital Signs: Acute • Continue medications:
of abdominal pain. BP: 110/60 mmHg Gastroenteritis • IVFT: Lactated Ringer’s
(+) 2 episodes of RR: 20 cpms with Moderate Solution to run at 100
loose stools T: 36. 2 Dehydration sec. cc/hour
(-) Vomiting P: 101 bpm to Amoebiasis • Soft diet
(-) Fever O2 sat: 98% • Monitor vital signs and
(-) Cough Intake q 4 hours
Awake, alert, not in • Monitor Intake and
respiratory distress Output
(-) Sunken eyeballs
Moist oral mucosa
THIRD HOSPITAL DAY
S O A P
(-) Abdominal Pain Vital Signs: Acute • Continue medications:
(-) Fever BP: 110/60 mmHg Gastroenteri • IVFT: Lactated Ringer’s
(-) Loose stools RR: 20 cpms tis with Solution to run at 100
(-) Vomiting T: 36. 2 Moderate cc/hour
P: 87 bpm Dehydration • Soft diet
O2 sat: 98% sec. to • Monitor vital signs and
Amoebiasis Intake q 4 hours
Awake, alert, not in • Monitor Intake and Output
respiratory distress • Repeat CBC
(-) Sunken eyeballs
Moist oral mucosa
FOURTH HOSITAL DAY
S O A P

(-) Abdominal Pain Vital Signs: Acute Gastroenteritis • For discharge

(-) Fever BP: 110/60 mmHg with Moderate • Home
(-) Loose stools RR: 20 cpms Dehydration; Intestinal medications:
(-) Vomiting T: 36. 2 Amebiasis Metronidazole 500 mg
P: 87 bpm tab TID PO for 10
O2 sat: 98% days
Diloxinide Furoate
Awake, alert, not in 500mg tab TID PO for
respiratory distress 10 days
(-) Sunken eyeballs • Diet As Tolerated
Moist oral mucosa • Proper handling of
food
• Follow-up
 MANAGEMENT
Admit
to ward Metronidazole
Metronidazole
HNBB 10
500
500 mg
mg IV
IV mg every
every
every 88 hours
hours 8 hours
for
abdominal
pain

Start
PNSS Diloxanide
Diloxanide
Monitor furoate
furoate
I&O and Metoclopramide 500
500
vital signs 10 mg IV mg/tab
mg/tab
every 8 hours TID
TID
for vomiting
ALGORITH
M
 FINAL DIAGNOSIS: Acute Gastroenteritis with Moderate Dehydration sec. to Amoebiasis

Transmission of pathogens that may cause acute infectious diarrhea can be prevented by hand hygiene promotion, access to clean
and safe water, proper food handling, proper excreta disposal, vaccination, supplements, and breastfeeding. Proper practices
destroy breeding grounds for pathogens and minimizes probable exposure to these pathogens that may enter our digestive system
and may cause acute infectious diarrhea. Also, with acute symptoms, patient should also know how to rehydrate with oresol mixture
and proper health seeking behavior should symptoms persist.