Pharmapedia Pro
Back to Ward Guide
Common Medical Emergencies

Acute Diarrhoea and Vomiting and Prevention of Acute Renal Failure

Not yet clinically reviewed

This protocol was migrated from the earlier Pharmapedia and Ward Guide apps for educational use. Follow your hospital's own policies and consult seniors when in doubt.

  1. Check pulse and blood pressure, see whether the patient is febrile or not, try to differentiate between large bowel diarrhea (colitis) and small bowel diarrhea (e.g., cholera). Assess severity of dehydration by postural symptoms, tachycardia, postural hypotension, signs of shock, skin turgor.
  2. Postural hypotension or postural syncope indicates more than 10% of blood volume loss, and hence requires IV fluids. If the blood pressure is normal and there is no postural fall give only oral fluids after controlling vomiting. Inj. Metoclopramide or Phenergan may be given to control vomiting. If vomiting persists start IV fluids even if blood pressure is normal.
  3. If there are signs of severe dehydration or oliguria and features of pre-renal uremia, follow the guidelines as below.
  • Put a large bore IV cannula (Venflon) or do a cut down
  • Correct dehydration with normal saline and dextrose. In severe dehydration or in severe diarrhea metabolic acidosis is common hence soda bicarb 50-100 ml 8 hourly can be given (added to dextrose or saline)
  • After correcting the dehydration, usually, urine output is established and then potassium replacement can be given (or even before if hypokalemia is documented)
  • If oliguria or anuria persists with uremic symptoms (tachypnoea, drowsiness, hiccup, nausea, vomiting) give Inj. Lasix 100-200 mg IV stat, this will usually establish diuresis. Even if patient has gone into acute renal failure (ATN), an oliguric renal failure (which requires dialysis) can be converted into a non-oliguric renal failure (which does not require dialysis) by early correction of dehydration and frusemide administration
  • Do not give potassium supplements till the patient passes urine or till hypokalemia is documented
  • Start drugs for the cause of diarrhea and vomiting without any delay, e.g. Tetracycline in cases of suspected cholera; antacids in severe gastritis and Tab Albact (norfloxacin) in Bacillary dysentery
  • Prevent acute renal failure due to hypovolemia by early correction of dehydration (oral rehydration therapy)
  • Advise about measures to prevent further spread of the infection to contacts (use of soap, water and common sense)