One of the top killers worldwide is dehydration from diarrhea which counts for hundreds of thousands of deaths each year. Diarrhea and pneumonia are still causing 1.5 million deaths each year.

During the Tropical Medicine and Infectious Diseases in an International Military Context conference, last week held in Hamburg, Germany one of the more interesting presentations was an update on the treatment of diarrhea for deployed troops. Dr Lalani from the US military medical school discussed the treatment of diarrhea using a combination of Loperamide and antibiotics:

Mild Diarrhea: Does not affect daily activities and involves 1-3 loose stools per day. Treatment is to hydrate and take Imodium.

Moderate Diarrhea: Affects daily activities and involves 3-5 loose stools per day, but no fever or blood in the stool. Treatment is to hydrate and take antibiotics and Imodium.

Severe Diarrhea: Casualty is no longer able to ambulate and involves 5+ loose stools per day. They may have a fever and/or bloody stools. Remember that any fever in a tropical environment is to be considered malaria until proven otherwise. Treatment is to hydrate and give antibiotics. Loperamide is contraindicated for any bloody diarrhea.


There has been a discussion that probiotics may prevent diarrhea but Dr. Lalani debated that there is no evidence that proves this concept.

“Rehydration is the cornerstone of diarrhea management” – Dr. T. Lalani

For the Remote Medic, rapid rehydration for any case of moderate to severe diarrhea is paramount. Oral rehydration is limited to one liter per hour. Supplemental intravenous rehydration will be helpful for any case of altered mental status or any additional signs of hypovolemia. We must be quick to assess and treat dehydration before it evolves into moderate or severe complications.


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