1. Increase Fluid Intake: Drink plenty of fluids, especially water, to compensate for the fluid loss caused by diarrhea. It's important to sip small amounts frequently rather than large quantities at once to avoid upsetting the stomach[1][2][3].
2. Use Oral Rehydration Solutions (ORS)**: ORS contain a balanced mix of salts and sugars that help replenish electrolytes lost during diarrhea. Products like Pedialyte or homemade solutions can be effective. Coconut water is also a good natural alternative as it contains electrolytes without added sugars[1][3][4].
3. **Consume Electrolyte-rich Drinks**: In addition to ORS, drinks such as broths, fruit juices, and sports drinks can help maintain electrolyte balance. However, be cautious with sports drinks as they may contain high sugar levels, which can worsen diarrhea[2][3][4].
4. **Eat Water-rich Foods**: Foods like gelatin, ice pops, and broth-based soups can contribute to fluid intake. The BRAT diet (bananas, rice, applesauce, toast) is gentle on the stomach and can be consumed if solid foods are tolerable[2][3].
5. **Monitor for Dehydration Symptoms**: Be vigilant for signs of dehydration, such as extreme thirst, dark urine, fatigue, dizziness, and dry skin. In children, additional signs include no tears when crying and sunken eyes[1][2][4].
IV fluids are crucial in managing severe or persistent diarrhea, especially when oral rehydration is insufficient or not feasible. The goals are to correct fluid and electrolyte losses, maintain perfusion, and prevent complications like shock or acute kidney injury.
Signs of moderate to severe dehydration:
Hypotension, tachycardia, dry mucosa, sunken eyes, poor skin turgor
Inability to tolerate oral intake (due to vomiting or altered mental status)
Persistent high-volume diarrhea
Electrolyte imbalances (hypokalemia, hyponatremia, etc.)
Suspected or confirmed hypovolemic shock
Underlying comorbidities (e.g., diabetes, renal insufficiency)
0.9% Normal Saline (NS) or Lactated Ringer's (LR):
Bolus of 20 mL/kg over 30–60 minutes
Reassess and repeat if needed
Based on ongoing losses and maintenance needs:
Typical: D5 0.45% NS with 20 mEq KCl/L (if potassium is low or normal)
Adjust based on:
Serum electrolytes
Urine output
Ongoing diarrhea losses
Vital signs, mental status, urine output
Daily weights (if inpatient)
Serum electrolytes, BUN, creatinine every 6–12 hours initially
Stool output volume if high-output diarrhea
Hypokalemia is common in diarrheal losses — replete cautiously.
Metabolic acidosis may occur due to bicarbonate loss in stool — usually corrects with volume resuscitation.
In children or elderly, fluid management should be carefully titrated to avoid overload.
Consider adding zinc supplementation in persistent diarrhea, especially in malnourished or pediatric patients.
Infectious gastroenteritis (e.g., cholera, severe bacterial infections)
Inflammatory bowel disease flares
C. difficile colitis
Malabsorption syndromes with volume depletion
Laxative abuse
Let me know if you'd like a sample IV fluid order or guidance on fluid rates for a specific weight or clinical scenario.