title: Diarrhoea in the critically ill.
abstract: OBJECTIVE
  To summarize existing evidence on definition, epidemiology, mechanisms, risk factors, consequences, outcome and management of diarrhoea in the critically ill.
  
  
  RESULTS
  In health, diarrhoea is defined as the passage of three or more loose or liquid stools per day. In the critically ill, the diagnosis is yet to be formalized and reported prevalence of diarrhoea varies according to the definition used. Recent studies estimate the prevalence between 14 and 21% and describe risk factors for diarrhoea in critically ill patients. The precipitant of diarrhoea always needs to be identified, as targeted therapies are important for several causes. Although the majority of patients with diarrhoea require only supportive care, it is always essential to exclude, or confirm and treat infectious diarrhoea. There is little evidence to support delaying or withdrawing provision of enteral nutrition in patients with diarrhoea, and we recommend continuing enteral nutrition whenever possible. However, the consequences of diarrhoea - hypovolaemia, electrolyte disturbances, malnutrition, skin lesions and contamination of wounds - should be avoided or at least recognized promptly.
  
  
  CONCLUSIONS
  A definition of diarrhoea and a practical approach to identify the precipitant and to manage diarrhoea in critically ill patients are proposed.
authors.affiliation: aDepartment of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, Lucerne Cantonal Hospital, Lucerne, Switzerland bDepartment of Anaesthesiology and Intensive Care, University of Tartu, Tartu, Estonia cDepartment of Critical Care Services, Royal Adelaide Hospital, Adelaide dDiscipline of Acute Care Medicine, University of Adelaide, Royal Adelaide Hospital, Adelaide, South Australia, Australia eDepartment of Anesthesiology and Intensive Care Medicine, Division of Anaesthesiology for Cardiovascular Surgery and Intensive Care Medicine, Medical University of Graz, Graz, Austria.
authors.forename: Annika
authors.initials: A
authors.lastname: Reintam Blaser
authors.forename: Adam M
authors.initials: AM
authors.lastname: Deane
authors.forename: Sonja
authors.initials: S
authors.lastname: Fruhwald
mesh_terms: D016638:Critical Illness; D003937:Diagnosis, Differential; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D004750:Enteral Nutrition / Q000379:methods; D006801:Humans; D012307:Risk Factors; D012720:Severity of Illness Index