7djtK7kw4

DIARRHOEARecognise the ill patient with diarrhoea needing urgent attention:Diarrhoea and 1 or more of the following:• Reliable signs of dehydration--Postural hypotension (systolic BP drop > 20mm Hg between lying and standing)--Poor urine output--Altered mental state (confused or drowsy)Management:• Oral rehydration (IV if unable to keep fluids down)• If patient has had diarrhoea for ≥ 2 weeks send stool sample for ‘ova, cysts and parasites’. Indicate on the request form if the patient has HIV.• Refer same day.Approach to the patient with diarrhoea not needing urgent attention:• Confirm that this is in fact diarrhoea: 3 or more watery stools per day.• Routine antibiotics are unnecessary and increase the likelihood of antibiotic resistance and side effects.• Knowing the patient’s HIV status helps in the management. If status unknown, test for HIV 60.• Advise patient to increase fluid intake, eat small frequent meals and avoid milk products, caffeinated drinks and high-fat, high-fibre foods.• Ask about duration of diarrhoea.Diarrhoea for < 2 weeks• Give oral rehydration.• Record current weight in patient notes.• Is the temperature ≥ 38°C and/oris there blood and/or mucus in thestool?YesNoDiarrhoea for ≥ 2 weeks• Give oral rehydration solution to prevent dehydration.• Send stool for ‘ova, cysts and parasites’. Indicate on request form if patient has HIV.• Knowing the patient’s HIV status helps in the management. If status unknown, test for HIV 60.HIV positive• Give routine HIV care 61.• ddI and lopinavir/ritonavir can cause ongoing loose stools.• Review symptoms and stool result in 1 week.HIV negativeGive metronidazole 2g daily for 3 days totreat empirically for giardiasis. Advise patientto avoid alcohol for 48 hours after last dose.Treat withciprofloxacin500mg 12 hourlyfor 3 days.Give loperamide4mg initially, then2mg after each loosestool, maximum12mg/day.Isospora belli• Give co-trimoxazole320/1600mg (4 tablets) 12hourly for 10 days.• Patient needs ART 61.CryptosporidiumPatient needs ART 61.Stool negativeReview stool result.Stool positiveGive loperamide 2mg as needed up to 12mg/day.Treat according to result.Review in 2 weeks if diarrhoea still present.If diarrhoea persists despite treatment, refer for specialist review.21