Questionnaire/history: Diarrhoea? - Duration? - > 10 days? - Frequency within 24 hours? - > 6x/24h? - Consistency? - Blood, mucus or pus in stools? - Faecal incontinence? Nausea? Vomiting? - Intractable? - Bilious? - Duration? - Frequency within 24 hours? Ability to eat and drink? Abdominal pain? Systemic features? - Fever? - Malaise? Signs and symptoms of dehydration? - Mild (eg lassitude, anorexia, nausea, light headedness, postural hypotension)? - Moderate? - Apathy/tiredness? - Dizziness? - Nausea? - Muscle cramps? - Pinched face? - Sunken eyes? - Dry tongue? - Reduced skin elasticity? - Postural hypotension (systolic blood pressure > 90 mmHg)? - Tachycardia? - Oliguria - Severe? - Profound apathy? - Weakness? - Confusion, leading to coma? - Marked peripheral vasoconstriction? - Hypotension? - Tachycardia? - Uraemia, oliguria or anuria? - Shock? Other symptoms? Recent contact with someone with acute diarrhoea and/of vomiting? Exposure to a possible source of enteric infection (eg contaminated water or food/eating out)? Recent travel abroad? Recent antibiotics or hospital admission within the last 8 weeks? Past medical history? Current medication? - Drugs that can exacerbate dehydration and renal failure? - Immunosuppressants? - Systemic steroids? - Proton-pump inhibitors? - H2-receptor antagonists? - Simple antacids? - Angiotensin-converting enzyme inhibitors? - Diuretics? Drug allergies? Social history? - Level of support? Examination: Consciousness level? Skin? BP? Pulse? Temperature CRT? Neck stiffness? Chest? Abdomen? Investigations: Stool sample if? - Systemically unwell? - Blood and/or mucus in the stool? - Immunocompromise? - Questionnaire/history of recent hospitalization and/or antibiotic treatment? - Recently been abroad to anywhere other than Western Europe, North America, Australia or New Zealand? - Diarrhoea has not improved by day 7? - Gardia suspected? - Uncertainty about the diagnosis of gastroenteritis? Management:

Advised:

To sip/drink water to replace fluid loss

Good hygiene

To gradually re-introduce usual diet after vomiting has stopped

Paracetamol for pain relief prn

Buscopan for stomach cramps prn

Buccastem M Buccal for nausea/vomiting prn

To not attend work or other institutional/social settings until at least 48 hours after the last episode of vomiting or diarrhoea

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 worse 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'

Arranged emergency transfer to hospital as eg

- Vomiting and unable to retain fluids?

- Features of severe dehydration or shock?

Advised:

- To encourage fluid intake (especially if supplemented with fruit and soups)

- To supplement fluid intake with oral rehydration salt solution if increased risk of a poor outcome (eg people who are 60 years of age or older, frail, or with comorbidities with which dehydration, hypovolaemia or haemoconcentration would be a problem (eg cardiovascular disease or thrombotic tendencies)

- After rehydration to consume solid food guided by appetite (small, light, non-fatty, and non-spicy meals may be better tolerated)

- To wash hands thoroughly with (preferably liquid) soap in warm running water and careful drying after going to the toilet, changing babies' nappies, and before preparing or serving food or eating meals

- To not share towels and flannels

- To use a flush toilet if possible, if a commode or bedpan must be used, to handle it with gloves, to dispose the contents into the toilet, and to then wash the container with hot water and detergent and allowed it to dry

- To wash soiled clothing and bed linen separately from other clothes and at the highest temperature they will tolerate (for example 60°C or higher for linen), after removal of excess faecal matter into the toilet

- To make sure that the washing machine is not be more than half full to allow for adequate washing and rinsing

- To clean toilet seats, flush handles, wash-hand basin taps, surfaces, and toilet door handles at least once daily with hot water and detergent

- Not to go to work or other institutional settings until at least 48 hours after diarrhoea and vomiting has stopped

- Loperamide for symptomatic control if mild-to-moderate diarrhoea, but not if blood and/or mucus in the stools or higher fever, and anti-emetics if severe vomiting

- To seek urgent medical advice if intractable or bilious vomiting, severe dehydration or shock, new features like blood, mucus and/or pus in the stool or symptoms do not resolve within the expected timeframe (such as diarrhoea has not resolved by day 7)

Reference(s): NICE CKS: Adult gastroenteritis Information for patient/carer(s): NHS Health A to Z: Diarrhoea and vomiting NHS Health A to Z: Food poisoning Patient UK: Gastroenteritis Patient UK: Food poisoning