- Hypovolemia and dehydration are the most common metabolic disturbances of diarrhea.
- The most common electrolyte disturbance is hypokalemia.
- The most common acid-base imbalance is metabolic acidosis because of loss of bicarbonate.
- Other complications include hypoproteinemia with exudative diarrhea → edema and effusions, and endotoxemia or septicemia Shock: septic → fever, hypoglycemia and shock Shock .
- Emergency treatment of severe hypovolemia or shock:
- Rapid intravenous infusion of synthetic colloids e.g. gelofusin or Hartmann's solution is needed to restore vascular volume and tissue perfusion.
- Patients in a less critical condition can be given Hartmann's solution at a slower rate, eg 40 ml/kg/hr to restore circulating volume. Then slow infusion rate and adjust fluid as required.
- Mild dehydration may be treated with oral fluid therapy with glucose/electrolyte solutions as long as the patient is not vomiting.
- Serum electrolyte levels (sodium Blood biochemistry: sodium , potassium Blood biochemistry: potassium , chloride Blood biochemistry: chloride ) should be checked. Supplementation of potassium Potassium chloride / gluconate may be required.
- Colloids or plasma are required in patients with hypoproteinemia.
- Mild to moderate acidosis will be controlled with infusion of Hartmann's solution.
- Supplement bicarbonate if pH <7.1.