Acute diarrhea natural history, complications and prognosis
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Untreated cases of acute diarrhea may progress to develop symptoms of fluid depletion including altered mental status, electrolyte imbalances, dehydration, metabolic acidosis and malnutrition. Common complications of acute diarrhea include confusion, convulsions, sepsis, and death. Prognosis is generally good, when the underlying cause is identified and treated early.
Natural History, Complications, and Prognosis
If left untreated, patients with acute diarrhea may develop symptoms and signs of dehydration (dry mouth and tongue, sunken eyes, confusion, lethargy, poor skin turgor, delayed capillary refill), malnutrition, altered mental status, sepsis, electrolyte imbalance, metabolic acidosis and eventually develop hypovolemic shock, coma or death. Acute diarrhea may also progress to chronic diarrhea in a small fraction of cases.
- Common complications of acute diarrhea include:
- Examples of certain postinfectious manifestations associated with some enteric pathogens include:
- Erythema nodosum
- Aortitis, osteomyelitis, extravascular deep tissue focus
- Ekiri syndrome (lethal, toxic encephalopathy) and/or seizure
- Intestinal perforation
- Postinfectious irritable bowel syndrome
- Reactive arthritis
- Immunoglobulin A nephropathy
- Hemolytic uremic syndrome
- Hemolytic anemia
- Guillain-Barré syndrome
Acute diarrhea is usually self limiting and has good prognosis, when the underlying cause is identified and treated. The presence of the following features in a patient with acute diarrhea for over 4 weeks may indicate poor prognosis:
- Weight loss
- Rectal bleeding
- Hemolytic uremic syndrome with EHEC infection
- Gullian barre syndrome with Campylobacter infection
- Toxic megacolon
- Associated psychological factors
- Dietary causes of diarrhea
- Age > 50 years
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