A fictional inpatient develops frequent diarrhoea, abdominal pain, fever, rising white-cell count and worsening renal function after broad-spectrum antibiotics.
Frame the danger first.
- New diarrhoea after healthcare exposure or antibiotics warrants infection-control and diagnostic consideration.
- Systemic toxicity, severe abdominal pain, distension or organ dysfunction suggest severe disease.
- Ileus can occur in severe disease and may reduce stool output rather than reassure.
Act, escalate, reassess.
- Isolate and initiate local infection-prevention measures promptly.
- Assess ABCDE, hydration, abdominal signs, organ function and alternative causes of deterioration.
- Use current local microbiology/antimicrobial guidance and seek early infection, gastroenterology and surgical advice for severe disease.
- Monitor for toxic megacolon, perforation, shock and need for critical care.
Red flags that change pace.
- Hypotension, rising lactate, acute kidney injury or altered mental state
- Abdominal distension, peritonism, ileus or escalating pain
- Rapidly worsening inflammatory markers or failure to respond to treatment
What makes care less safe.
- Treating diarrhoea alone without assessing severity
- Missing ileus as a severe-disease presentation
- Delaying surgical discussion in a deteriorating patient
Say the concern plainly.
Suspected severe C. difficile: stool and antibiotic history [summary], physiology/renal function [trend], abdomen [findings], isolation/testing [status] and microbiology/surgical plan [details].