Treatment Guideline Chart
Diarrhea is a change in normal bowel movements characterized by increase in frequency, water content or volume of stools. The usual stool output is 10 g/kg/day.
Acute diarrhea lasts ≤14 days while chronic diarrhea lasts >14 days.
Infectious diarrhea is usually associated with symptoms of nausea and vomiting and abdominal cramps.

Gastroenteritis%20-%20bacterial Signs and Symptoms


Watery Diarrhea

  • Semi-formed to loose-watery stools without the presence of blood
  • Often clinical presentation of enterotoxin-induced diarrhea

Bloody Diarrhea

  • Bloody diarrhea is considered if macroscopic exam of stools contains blood


  • Diarrhea is defined as any change in normal bowel movements characterized by increase in frequency, water content or volume of stools or with bloody stools
    • Usual stool output is 10 g/kg/day
  • Infectious diarrhea is defined as diarrhea of infectious origin and is usually associated with symptoms of nausea and vomiting (N/V), fever  and abdominal cramps


  • Usually affects children >2 years of age
  • Transmission is through fecal-oral route, ingestion of contaminated meat, or exposure to poultry and other farm animals


  • Common pathogens causing pediatric bacterial gastroenteritis include Escherichia coli, Salmonella sp, Shigella sp, Clostridiodes difficile, Campylobacter jejuni, and Yersinia enterocolitica

Traveler's Diarrhea 

  • Causes of acute traveler’s diarrhea will vary from one geographical area to another
  • Enterotoxigenic E coli is one of the most frequently identified organisms
  • Campylobacter infections seem to predominate as the cause of traveler’s diarrhea in North Africa and Southeast Asia
  • Other common bacterial causes: Enteroaggregative E coli (EAEC), Salmonella, Shigella sp, Campylobacter jejuni

Watery Diarrhea

  • Severe dehydration with severe watery diarrhea is most likely caused by Vibrio cholerae subgroup O1 
  • Vibrio O139, other non-O1 vibrios and occasionally Vibrio parahaemolyticusAeromonas sp and enteropathogenic/enterotoxigenic Escherichia coli can cause a similar clinical picture (though diarrhea by these organisms usually causes milder forms of diarrheal illness)

Bloody Diarrhea 

  • Shigella sp and Campylobacter jejuni
    • Shigella dysenteriae and Shigella flexneri may cause a more severe disease with high fever
    • Shigella boydii and Shigella sonnei cause a milder disease
  • Salmonella enteritidis, Yersinia enterocolitica, C difficile, Balantidium coli, Plesiomonas, enterohemorrhagic E coli (EHEC) and enteroinvasive E coli (EIEC) can produce bloody diarrhea

Signs and Symptoms

Associated Symptoms  

  • Frequency and intensity of nausea and vomiting, abdominal pain, cramps, myalgia, headache, altered sensorium

Symptoms of Volume Depletion

  • Thirst
  • Tachycardia
  • Orthostasis
  • Decreased urination
  • Decrease in skin turgor
  • Lethargy


  • Highly suggested by severe profuse watery diarrhea and dehydration
  • Other clinical features: Very abrupt onset of acute diarrhea with rapid progression to severe dehydration, the presence of muscle cramps but no fever or abdominal pain
  • Stools are usually greenish-yellow, clear, watery with little food residue

Bloody Diarrhea

  • Patients often have fever that may last >2 days and might be high (>38.5°C)
  • May initially suffer with watery diarrhea that rapidly changes to bloody diarrhea and dysentery
  • Mild dehydration
  • Red blood cell (RBC) and white blood cell (WBC) are found on microscopic exam of the stools
  • Dysentery
    • Suggested by frequent passage (10-30x/day) of small-volume stools that consist of blood, mucus and pus
    • Patient usually suffers abdominal cramps and tenesmus

Risk Factors

  • Travel to developing/underdeveloped areas
  • Daycare attendance
  • Ingestion of unsafe foods (eg unpasteurized dairy products, undercooked meats, seafood)
  • Swimming/drinking untreated fresh water
  • Poor personal and public hygiene (eg seldom practice of handwashing)
  • Visit to farm or contact with pets with diarrhea
  • Knowledge of other ill persons
  • Recent or regular medications (eg antibiotics)
  • Underlying medical conditions (eg AIDS, immunosuppressants)
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