Gastroenteritis in adults
Questionnaire/history:
Diarrhoea?
- Onset?
- Duration?
- Frequency within 24 hours?
- Consistency?
- Blood, mucus or pus in stools?
- Faecal incontinence?
Nausea?
Vomiting?
- Intractable?
- Bilious?
- Onset?
- Duration?
- Frequency within 24 hours?
Ability to eat and drink?
Abdominal pain?
Systemic features?
- Fever?
- General malaise?
Signs and symptoms of dehydration?
- Mild?
-- Lassitude?
-- Nausea?
-- Light headedness?
-- Postural hypotension?
- Moderate?
-- Apathy/tiredness?
-- Dizziness?
-- Muscle cramps?
-- Pinched face?
-- Sunken eyes?
-- Dry tongue?
-- Reduced skin elasticity?
-- Postural hypotension (systolic blood pressure < 90 mmHg)?
-- Tachycardia?
-- Low urine output (100-400 mL per day) (oliguria)?
- Severe?
-- Profound apathy?
-- Weakness?
-- Confusion, leading to coma?
-- Marked peripheral vasoconstriction?
-- Hypotension?
-- Tachycardia?
-- Oliguria or anuria (less than 100 mL of urine per day)?
-- Shock?
Other symptoms?
Currently fluid intake?
Current food intake?
Current urinary output?
Recent contact with someone with acute diarrhoea and/of vomiting or outbreak?
Recent food intake (for example barbecue or restaurant, and types of food eaten) that may suggest food poisoning as a cause?
Recent exposure to untreated or potentially contaminated water?
Recent travel abroad (which country and region visited)?
Recent antibiotics (in the last 8 weeks)?
Recent proton pump inhibitor in the last 8 weeks)?
Recent hospital admission (in the last 8 weeks) ?
Past medical history?
- Immunosuppression?
Current medication?
- Drugs that can exacerbate dehydration and acute kidney injury?
-- ACE inhibitor?
-- Diuretic?
-- Antibiotics?
-- NSAIDS?
-- Proton-pump inhibitors?
-- Allopurinol?
-- Chemotherapy?
- Drugs which efficacy may be affected by severe diarrhoea or vomiting?
-- Warfarin?
-- Anticonvulsants?
-- Oral contraceptive pill?
Drug allergies?
Social history?
- Level of support?
Occupational history, if appropriate, such as food handler, healthcare or social care worker, or nursery worker?
Examination:
Consciousness level?
Skin?
BP?
Pulse?
Temperature?
CRT?
Neck stiffness?
Breathing pattern?
Abdomen?
Investigations:
Stool sample if?
- Systemically unwell?
- Blood and/or mucus in the stool?
- Immunocompromise?
- Recent antibiotic or proton pump inhibitor treatment or recent hospital admission?
- Recent travel abroad to anywhere other than Western Europe, North America, Australia or New Zealand?
- Diarrhoea has not improved by day 7?
- Suspected food poisoning?
- Diarrhoea recurrent or prolonged (over 14 days)?
- Diarrhoea in a person at risk of transmission of infection?
- Uncertainty about the diagnosis?
- Contact with an affected person or outbreak of diarrhoea?
Management:
Advised:
Prevention/treatment of dehydration:
- Regular fluid intake and supplement with fruit juice and soups if needed
- Oral rehydration salt solution as supplemental fluid if risk of dehydration if risk of dehydration
If clinical features of dehydration 200-400 mL oral rehydration salt solution after every loose motion, dose according to fluid loss
Transmission prevention:
- To wash hands thoroughly with liquid soap in warm running water and dry careful
- To not share towels and flannels
- To wash soiled clothing and bed linen separately from other clothes and at a high temperature (for example 60°C or higher for cotton) after removal of excess faecal matter or vomitus into the toilet and the washing machine not more than half full
- To not attend work or other institutional/social settings until at least 48 hours after the last episode of diarrhoea or and vomiting
Antidiarrhoeal drugs may be usual for symptom relief (if mid-to-moderate diarrhoea without blood, mucus and/or pus or fever or suspected shigellosis) for example to resume essential activities
After rehydration and vomiting has stopped to gradually reintroduce usual diet, small, light, non-fatty, non-spicy meals may be better tolerated
Antidiarrhoeal drugs may be usual for symptom relief (if mid-to-moderate diarrhoea without blood, mucus and/or pus or fever or suspected shigellosis) for example to resume essential activities
Paracetamol for pain relief prn
Buscopan for stomach cramps prn
Buccastem M Buccal for nausea/vomiting prn
To call back or go to A&E if new or worsening sxs (esp if worsening vomiting, not being able to keep fluids, blood and/or mucus in stools, feeling generally more unwell with eg dizziness)
To contact own GP or call back 111 if no impr within the next 24 hours or ongoing sxs (eg vomiting for more than 1-2 days and/or diarrhoea for more than 1 week)
To visit nhs.uk to read PIL 'Diarrhoea and Vomiting' and patient.info to read PILs 'Nausea and Vomiting' and 'Diarrhoea'
Reference(s):
NICE CKS: Gastroenteritis. Last revised in May 2024
Information for patient/carer(s):
NHS Health A to Z: Diarrhoea and vomiting. Last reviewed: 12 December 2023
NHS Health A to Z: Food poisoning. Last reviewed: 18 June 2021
Patient UK: Gastroenteritis. Lasted version: 27.09.23
Patient UK: Food poisoning. Latest version: 22.01.23
With references:
Questionnaire/history:
Diarrhoea? NICE CKS: Gastroenteritis. Last revised in May 2024
- Onset? NICE CKS: Gastroenteritis. Last revised in May 2024
- Duration? NICE CKS: Gastroenteritis. Last revised in May 2024
- Frequency within 24 hours? NICE CKS: Gastroenteritis. Last revised in May 2024 : 'Frequency'
- Consistency? clinical-templates.com
- Blood, mucus or pus in stools? NICE CKS: Gastroenteritis. Last revised in May 2024
- Faecal incontinence? clinical-templates.com
Nausea? NICE CKS: Gastroenteritis. Last revised in May 2024
Vomiting? NICE CKS: Gastroenteritis. Last revised in May 2024
- Intractable? clinical-templates.com
- Bilious? clinical-templates.com
- Onset? clinical-templates.com
- Duration? clinical-templates.com
- Frequency within 24 hours? clinical-templates.com
Ability to eat and drink? clinical-templates.com
Abdominal pain? NICE CKS: Gastroenteritis. Last revised in May 2024
Systemic features?
- Fever? NICE CKS: Gastroenteritis. Last revised in May 2024
- General malaise? NICE CKS: Gastroenteritis. Last revised in May 2024
Signs and symptoms of dehydration?
- Mild? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Lassitude? NICE CKS: Gastroenteritis. Last revised in May 2024-- Anorexia and nausea? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Light headedness? NICE CKS: Gastroenteritis. Last revised in May 2024-- Postural hypotension? NICE CKS: Gastroenteritis. Last revised in May 2024
- Moderate? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Apathy/tiredness? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Dizziness? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Nausea? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Muscle cramps? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Pinched face? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Sunken eyes? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Dry tongue? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Reduced skin elasticity? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Postural hypotension (systolic blood pressure < 90 mmHg)? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Tachycardia? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Low urine output (100-400 mL per day) (oliguria)? NICE CKS: Gastroenteritis. Last revised in May 2024
- Severe? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Profound apathy? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Weakness? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Confusion, leading to coma? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Marked peripheral vasoconstriction? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Hypotension? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Tachycardia? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Oliguria or anuria (less than 100 mL of urine per day)? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Shock? NICE CKS: Gastroenteritis. Last revised in May 2024
Other symptoms? clinical-templates.com
Currently fluid intake? NICE CKS: Gastroenteritis. Last revised in May 2024
Current food intake? NICE CKS: Gastroenteritis. Last revised in May 2024
Current urinary output? NICE CKS: Gastroenteritis. Last revised in May 2024
Recent contact with someone with acute diarrhoea and/of vomiting or outbreak? clinical-templates.com
Recent food intake (for example barbecue or restaurant, and types of food eaten) that may suggest food poisoning as a cause? NICE CKS: Gastroenteritis. Last revised in May 2024
Recent exposure to untreated or potentially contaminated water? NICE CKS: Gastroenteritis. Last revised in May 2024
Recent travel abroad (which country and region visited)? NICE CKS: Gastroenteritis. Last revised in May 2024
Recent antibiotics (in the last 8 weeks)? NICE CKS: Gastroenteritis. Last revised in May 2024: 'Recent antibiotics'
Recent proton pump inhibitor in the last 8 weeks)? NICE CKS: Gastroenteritis. Last revised in May 2024: 'Recent proton pump inhibitor'
Recent hospital admission (in the last 8 weeks) ? NICE CKS: Gastroenteritis. Last revised in May 2024: 'Recent hospital admission'
Past medical history? clinical-templates.com
- Immunosuppression? NICE CKS: Gastroenteritis. Last revised in May 2024
Current medication? NICE CKS: Gastroenteritis. Last revised in May 2024
- Drugs that can exacerbate dehydration and acute kidney injury? NICE CKS: Gastroenteritis. Last revised in May 2024
-- ACE inhibitor? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Diuretic? NICE CKS: Gastroenteritis. Last revised in May 2024-- Antibiotics? NICE CKS: Gastroenteritis. Last revised in May 2024
-- NSAIDS? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Proton-pump inhibitors? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Allopurinol? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Chemotherapy? NICE CKS: Gastroenteritis. Last revised in May 2024
- Drugs which efficacy may be affected by severe diarrhoea or vomiting? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Warfarin? NICE CKS: Gastroenteritis. Last revised in May 2024-- Anticonvulsants? NICE CKS: Gastroenteritis. Last revised in May 2024
-- Oral contraceptive pill? NICE CKS: Gastroenteritis. Last revised in May 2024
Drug allergies? clinical-templates.com
Social history? clinical-templates.com
- Level of support? clinical-templates.com
Occupational history, if appropriate, such as food handler, healthcare or social care worker, or nursery worker? NICE CKS: Gastroenteritis. Last revised in May 2024
Examination:
Consciousness level? clinical-templates.com
Skin? clinical-templates.com
BP? NICE CKS: Gastroenteritis. Last revised in May 2024
Pulse? NICE CKS: Gastroenteritis. Last revised in May 2024
Temperature? NICE CKS: Gastroenteritis. Last revised in May 2024
Neck stiffness? clinical-templates.com
Breathing pattern? NICE CKS: Gastroenteritis. Last revised in May 2024
Abdomen? clinical-templates.com
Investigations:
Stool sample if? NICE CKS: Gastroenteritis. Last revised in May 2024
- Systemically unwell? NICE CKS: Gastroenteritis. Last revised in May 2024
- Blood and/or mucus in the stool? NICE CKS: Gastroenteritis. Last revised in May 2024
- Immunocompromise? NICE CKS: Gastroenteritis. Last revised in May 2024
- Recent antibiotic or proton pump inhibitor treatment or recent hospital admission? NICE CKS: Gastroenteritis. Last revised in May 2024
- Recent travel abroad to anywhere other than Western Europe, North America, Australia or New Zealand? NICE CKS: Gastroenteritis. Last revised in May 2024
- Diarrhoea has not improved by day 7? NICE CKS: Gastroenteritis. Last revised in May 2024
- Suspected food poisoning? NICE CKS: Gastroenteritis. Last revised in May 2024
- Diarrhoea recurrent or prolonged (over 14 days)? NICE CKS: Gastroenteritis. Last revised in May 2024
- Diarrhoea in a person at risk of transmission of infection? NICE CKS: Gastroenteritis. Last revised in May 2024
- Uncertainty about the diagnosis? NICE CKS: Gastroenteritis. Last revised in May 2024
- Contact with an affected person or outbreak of diarrhoea? NICE CKS: Gastroenteritis. Last revised in May 2024
Management:
Advised:
Prevention/treatment of dehydration: NICE CKS: Gastroenteritis. Last revised in May 2024
- Regular fluid intake and supplement with fruit juice and soups if needed NICE CKS: Gastroenteritis. Last revised in May 2024
- Oral rehydration salt solution as supplemental fluid if risk of dehydration if risk of dehydration NICE CKS: Gastroenteritis. Last revised in May 2024
If clinical features of dehydration 200-400 mL oral rehydration salt solution after every loose motion, dose according to fluid loss NICE CKS: Gastroenteritis. Last revised in May 2024
Transmission prevention: NICE CKS: Gastroenteritis. Last revised in May 2024
- To wash hands thoroughly with liquid soap in warm running water and dry careful NICE CKS: Gastroenteritis. Last revised in May 2024
- To not share towels and flannels NICE CKS: Gastroenteritis. Last revised in May 2024
- To wash soiled clothing and bed linen separately from other clothes and at a high temperature (for example 60°C or higher for cotton) after removal of excess faecal matter or vomitus into the toilet and the washing machine not more than half full NICE CKS: Gastroenteritis. Last revised in May 2024
- To not attend work or other institutional/social settings until at least 48 hours after the last episode of diarrhoea or and vomiting NICE CKS: Gastroenteritis. Last revised in May 2024
Antidiarrhoeal drugs may be usual for symptom relief (if mid-to-moderate diarrhoea without blood, mucus and/or pus or fever or suspected shigellosis) for example to resume essential activities NICE CKS: Gastroenteritis. Last revised in May 2024
After rehydration and vomiting has stopped to gradually reintroduce usual diet, small, light, non-fatty, non-spicy meals may be better tolerated NICE CKS: Gastroenteritis. Last revised in May 2024: 'After rehydration and vomiting has stopped to gradually reintroduce usual diet, small, light, non-fatty, non-spicy meals may be better tolerated'
Antidiarrhoeal drugs may be usual for symptom relief (if mid-to-moderate diarrhoea without blood, mucus and/or pus or fever or suspected shigellosis) for example to resume essential activities NICE CKS: Gastroenteritis. Last revised in May 2024
Paracetamol for pain relief prn clinical-templates.com
Buscopan for stomach cramps prn clinical-templates.com
Buccastem M Buccal for nausea/vomiting prn clinical-templates.com
To call back or go to A&E if new or worsening sxs (esp if worsening vomiting, not being able to keep fluids, blood and/or mucus in stools, feeling generally more unwell with eg dizziness) clinical-templates.com
To contact own GP or call back 111 if no impr within the next 24 hours or ongoing sxs (eg vomiting for more than 1-2 days and/or diarrhoea for more than 1 week) clinical-templates.com
To visit nhs.uk to read PIL 'Diarrhoea and Vomiting' and patient.info to read PILs 'Nausea and Vomiting' and 'Diarrhoea' clinical-templates.com