ICU GUIDELINE: MANAGEMENT OF DIARRHEA

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START
Stool output >3 - 5
No
liquid BM or > 750 mL
No Intervention.
over 24 h?

Yes
No Medical/surgical hx No No Receiving cathartic No
Distended, tympanic, Risk of stool impaction?
consistent with diarrhea? agents?
or painful abdomen? (see blue BOX - B)
(see purple BOX - A) (see orange BOX - C)

Yes Yes
Yes Yes
Discontinue EN.
MD to review patient. Medical intervention Rectal check; manual Change all oral liquid medications
as indicated. disimpaction if positive. to tablet or parenteral alternative;
Obtain abdominal x-ray change oral electrolyte solutions to
to rule out more proximal parenteral route; discontinue all
A: IBD, terminal ileal resection, chemotherapy, impaction as indicated. known cathartics (see BOX - C) if
short bowel, pancreatic insufficiency, etc. possible. Pharmacist to review
to rule out other potential drug
B: Chronic constipation, absent BM x 5 days, related cause of diarrhea.
regular narcotic use, limited fluid intake.

C: Citromag®, docusate, Milk of Magnesia® , Rule out C. difficile associated

cascara, enema, PEG, hypertonic or sorbitol- No diarrhea, bowel ischemia, other.
Initiate antidiarrhea agent.
containing liquid medications, oral electrolyte Diarrhea resolved? If all investigations negative,
Reassess need/dose daily.
solutions, lactulose, Kayexalate®, etc. consider fiber- containing formulae.

Developed by J. Greenwood, RD. Critical Care Program - Vancouver Coastal Health Authority. Modified for use by CCN (7/4/2010)