Acute diarrhea triage workflow

Scope

Use for

Initial outpatient assessment of acute community-onset diarrhea in adults who can be safely managed without hospital resuscitation.

Not for

• Severe dehydration or shock requiring emergency IV resuscitation pathway.
• Complex inpatient infectious-disease management scenarios.

Immediate actions

• Record stool frequency, duration, blood, fever, fluid intake, urine output, vital signs and mental status.
• Review travel/food/water exposures, sick contacts, antibiotics, recent healthcare exposure and immune status; identify outbreak or high-risk occupation concerns.
• Assess whether oral rehydration is safe; frailty, pregnancy and significant renal or cardiac disease require individualized assessment.

Red flags: escalate now

Treat these as urgent. Escalate early if concern persists or follow-up is unreliable.

• Arrange immediate ED assessment for hypotension, confusion, severe dehydration or severe persistent abdominal pain; use EMS for shock or unsafe transport.
• Bloody diarrhea with systemic illness, rapidly worsening symptoms or suspected hemolytic uremic syndrome needs urgent hospital assessment. Do not attribute reduced urine output solely to dehydration.
• Bloody stools, significant fever or immunocompromise warrant prompt clinical assessment and testing even if vital signs are stable.

First-line plan

• Use oral rehydration solution in small, frequent amounts for appropriate outpatients and reassess tolerance; tailor fluid advice in renal/cardiac disease.
• Stool testing is usually unnecessary for mild, improving illness. Investigate severe illness, immunocompromise or diarrhea lasting more than 7 days; choose pathogen and C. difficile testing with the local laboratory.
• Avoid routine empiric antibiotics. Suspected/confirmed Shiga toxin-producing E. coli requires prompt review and avoidance of antibiotics and antimotility drugs; avoid loperamide with bloody diarrhea or fever.

Follow-up and monitoring

• Give a dated reassessment plan; review sooner for poor intake or worsening illness and reassess persistent symptoms even if initial tests are negative.
• Track intake and urine output, and return urgently for bleeding, weakness, confusion or dehydration progression.
• Reinforce handwashing and food hygiene. Coordinate outbreak concerns and return-to-work restrictions with local public health; assign responsibility for pending stool results.

Before the patient leaves

Return precautions you can say as written:

“If symptoms get worse, new warning signs appear, or you cannot follow the plan from this visit, seek urgent care now.”

• Point to the red flags above that apply to this patient.
• Confirm follow-up timing and where to go after hours.
• Attach a relevant handout to reinforce the plan.
• Document disposition, rationale, unresolved uncertainty, and that precautions were understood.

About this workflow

Clinical owner

Family Medicine Editorial Team

Risk tier

Medium

Review cadence

Every 6 months

Last reviewed

September 4, 2026AI-assisted evidence review. Clinical-owner sign-off is not recorded for this update.

Review status

Evidence current. Next review due March 4, 2027.

References

• BC Guidelines Infectious diarrhea investigation (2022) (opens in a new tab)
• Emergency Care BC Oral rehydration for adults (2020) (opens in a new tab)
• IDSA Infectious diarrhea guideline (2017; US guidance) (opens in a new tab)