Treatment of Diarrhea – Flashcards
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What are the 3 components of treatment of acute diarrhea?
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1) supportive therapy/measures 2) specify therapy with antibiotics 3) symptomatic therapy
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What is the most important component of treatment?
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1) supportive therapy/measures
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What is the goal of the first component of treatment?
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To control secondary effects of 1)fluid and electrolyte loss and 2)acid-base imbalance.
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How do we accomplish the first component?
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1) rapid rehydration 2) refeeding (to introduce solids)
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What is more effective, oral therapy rehydration, or given I.V.?
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They are equally effective, therefore ORT is more common.
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Why do we need fluids and electrolytes and food for acute diarrhea?
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1) to replace electrolytes and fluids 2) to repair/regenerate villous cells damaged or killed by pathogens/toxins
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For adults, what should they do for the first 24 hours or until diarrhea lessens/stops?
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1) drink 2-3 clear fluids per day (broth based soups, juices with low sugar, sport drinks in reasonable amounts) 2)Gelatin 3) Oral rehydration fluids (gastrolyte, pedialyte etc.)
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What should adults do for the NEXT 24 hours or earlier if the individual has been rehydrated?
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1) introduce foods as tolerated 2) introduce foods as soon as possible after rehydration as this can typically shorten the course of diarrhea (complex carbs, cooked fruits/veggies, lean meats, cooked eggs, yogurt - unless they have a lactose intolerance)
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What type of foods should be avoided for diarrhea?
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fatty foods, foods with high simple sugars (tea, soft drinks, etc.) spicy, or other irritating foods.
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What's a disadvantage to using the BRAT diet (bananas, rice, applesauce, and toast)?
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Low energy source as well as low protein
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How long should a patient wait until they progress to a normal diet?
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2-3 days (or longer if there is still diarrhea present).
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When can children be treated in the same way as adults for diarrhea?
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if diarrhea is present for 1) less than 24 hours and 2) no signs of dehydration and/or high fever.
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When should you recommend a child to see a physician?
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If there are signs of dehydration, first give ORT, then recommend to see a physician!
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For initial rehydration, how much oral rehydration solution with sodium content should be given? (child)
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50-90 mEq/L
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How much ORT, INITIALLY, should be given for mild dehydration? for moderate? for severe? (child)
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1) 50mL/kg of oral rehydration solution over a 4-6 hour period. 2) moderate: 100ml/kg over 4-6 hours 3) severe: signs of shock, therefore child would normally be hospitalized and given i.v. of normal saline of 40mL/kg. ORT afterwards is given.
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For maintenance therapy of ORT, how much should be given? (child)
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40-60 mEq/L (if a solution with 50-90 mEq/L is used, then it should be alternated with liquids that have little to none solute content such as water)
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How much ORT should be given per day of total fluids for maintenance therapy? (child)
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150 ml/kg/day
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For ongoing stool looses, how would you treat a child?
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10ml/kg of body weight of ORT or 1/2-1 cup of ORT, FOR EACH DIARRHEA STOOL
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What is a disadvantage to using oral rehydration solutions for children? How can we counter this?
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Salty taste, therefore children may not want to drink them. To counter this we can start with small amounts frequently at first (every few minutes) to help them adapt to the taste, or freeze them into a popsicle.
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What would you do if children did not have signs of dehydration, but had diarrhea?
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1) Start with just maintenance therapy of ORT. (40-60mEq/litre, 150mg/kg/day). 2) feed appropriately
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What would you do if children did have signs of dehydration and diarrhea?
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1) rehydrate 2) feed age-appropriate diets as soon as they have been rehydrated.
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Is it safe to give milk for children with acute diarrhea? breast feeding? full strength animal milk?
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Yes. Yes. Yes.
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With regards to the second component, how should we choose an antibiotic?
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1) based on culture 2) based on sensitivity
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What are some selected cases we would use antibiotics?
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1) high fever 2) bloody stools
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Why are antibiotics not usually needed?
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Often the diarrhea has resolved by the time the culture and sensitivity has been confirmed.
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What is the aim of symptomatic therapy?
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To reduce the severity of diarrhea (or stop it) by decreasing the frequency, or increasing the consistency of bowel movements.
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What are the 3 drugs recommended to be therapeutically effective?
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1)polycarbophil 2) attapulgite 3) loperamide
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Give 1 dosing and regimen for a drug for adult:
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Attapulgite (Kaopectate): Adults - 1200mg (600mg tab, 300mg chew tab) initally, then 1200 mg after each bowel movement to 8 g/day. Polycarbophil (Mitrolan - 500mg chewable tablet, bulk fiber): Adult: 1g qid or prn (max 6g/day). Loperamide (imodium 2mg/capsule, 0.13mg/ml): adults: 4mg initially, then 2mg after each loose bowel movement (max 16mg/day).
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How long should any of the medications for diarrhea not be used for?
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Not longer than 2 days without medical supervision.
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What are the beneficial bacteria in probiotics, and what are they used for?
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Lactobacillus; used for prevention and treatment of diarrhea.
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What is the prescription drug used for diarrhea and its dosage?
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Lomotil (diphenoxylate-atropine): 2.5mg diphenoxylate, 0.025mg atropine/tablet. Give 5 mg (2 tablets) followed by 2.5mg after each loose BM to a max of 20mg/day (1 tablet for each BM): Max 8 tabs.
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What are the high risk areas for travellers' diarrhea?
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Centra and Latin america, africa, S.E. asia, middle east
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What is travellers' diarrhea defined as?
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1) more than 3 stools in 24 hour period 2) at least 1 symptom such as nausea, malaise, vomiting, abdominal cramps, fever, passage of bloody or mucoid stools Lasts 3-5 days
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What are the management measures for traveller's diarrhea?
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Prevention: (good hygiene, dietary measures, avoiding street vendor food etc, boil peel it cook it etc., do not drink tap water, avoid ice cubes, avoid locally prepared fresh fruit/veggies) 2) prophylaxis 3) treatment of TD
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Which patients should be considered for prophlaxis of TD?
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-Immunodeficiency -Elderly or debilitated individuals -those with increased risk of consequences of diarrhea (CHF, severe angina, renal problems, IBD etc.) -decreased stomach acid -gastric surgery -adventure travellers -children -individuals who frequently travel to developing countries on business
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What is 1 drug treatment for prophylaxis of TD?
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Bismuth subsalicylate: 524mg (2 tablets) QID. Protection rate of 62%. Begin on 1st day of travel, and continue for 1 or 2 days after leaving. antibiotics Live lactobacillus strains Dukarol - protection for 2 years (2 shots, separated by 7 days - give booster in 3 months if TD protection still required).
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What is 1 drug treatment for treating TD?
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a) Supportive measures/therapy (ORT treatments for children and adults) b) Specific therapies: Loperamide, Bismuth subsalicylate, Attapulgite Loperamide: (2mg/capsule, 0.13mg/ml) 4 mg initially, then 2mg after each loose BM to a a max of 16mg/day. Do not use for more than 2 days. Antibacterial agents if no response to nonspecific therapy, presence of blood, mucous in stool, development of a high fever. Probioitics (for non specific diarrhea)
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When would we refer an adult to a physician or a child over 3?
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-elderly -history of chronic medical conditions -fever above 39 degrees -blood in stool -presence of severe abdominal pain -high output of diarrhea -persistent vomiting -patients with sights or symptoms of dehydration -duration of more than 48 hours individual not drinking adequate amounts of fluids for rehydration
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When do we refer children under 3?
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-if they are <6 months or weight of <18kg -history of chronic medical conditions, premature birth -fever above 38 degrees -blood in still - high output of diarrhea
