Diarrhea OTC treatment

Diarrhea

abnormal (normal= 3X a day to 3X a week) increase in stool frequency, liquidity, or weight

abnormal= abnormal for the individual OR >3 per day

acute= symptoms for less than 14 days

persistent= 14-28 days

chronic= >28 days

OTC doesn’t treat chronic or persistent

Common causes

• Inflammatory vs. non-inflammatory, infectious vs. non-infectious

• Relation to meds, food intolerance, or non-GI acute/chronic illness

• Viral- water, foods, other individuals

• Bacterial

• Protozoal

Foodborne diarrhea

Generally viral or bacterial- may be caused by poor sanitation in food production or food contamination

Travelers’ diarrhea

Normal bacteria in locations, traveler is unfamiliar with, causes GI upset

Food-induced diarrhea

Food allergy

Excessively fatty or hi fiber containing foods

Vary in carb intake

Lactase enzyme deficiency

Clinical presentation of diarrhea

Abnormal increase in stool frequency, liquidity or weight

May be accompanied with fluid and electrolyte imbalance

Minimal or No dehydration signs (< = 3%)

Mental status: Good, alert

Thirst: Drinks normally/ refuses liquids

Heart rate: Normal

Quality of Pulse: Normal

Breathing: Normal

Eyes: Normal

Tears: Present

Mouth/ Tongue: Moist

Skin fold: Instant recoil

Capillary refill: Normal

Extremities: Warm

Urine output: Normal to decreased

Number of unformed stool/day: <3

Other signs/symptoms: Afebrile, normal BP, no orthostatic changes in BP/ pulse

*Take in what you lose- 1 watery bowel movement= 1 cup of fluids- maintain

Mild-Moderate dehydration (3-9%)

Mental status: Normal- irritable

Thirst: Thirsty, eager to drink

Heart rate: Normal to increased

Quality of Pulse: Normal to decreased

Breathing: Normal to fast

Eyes: Slightly sunken

Tears: Decreased

Mouth/ Tongue: Dry

Skin fold: Recoil in <2 seconds

Capillary refill: Prolonged

Extremities: Cool

Urine output: Decreased

Number of unformed stool/day: 3-5

Other signs/symptoms: Afebrile or fever, mild orthostatic BP/pulse changes

*2-4L of oral rehydration required in a 3-hour period, then maintain with 1 cup per bowel movement that is watery

Severy dehydration (>9%)

Mental status: Apathetic, lethargic, unconscious

Thirst: Drinks poorly, unable to drink

Heart rate: Tachycardia

Quality of Pulse: Weak

Breathing: Deep

Eyes: Deeply sunken

Tears: Absent

Mouth/ Tongue: Parched

Skin fold: Recoil in >2 seconds

Capillary refill: Prolonged, minimal

Extremities: Cold, cyanotic

Urine output: Minimal

Number of unformed stool/day: 6-9

Other signs/symptoms: Fever, hypotension, dizzy

Exclusions to selfcare

Any diarrhea <6 months of age

Moderate diarrhea <2 years of age

Severe dehydration at any age- no urine in 8 hrs, behavioral changes, no tears when cry

Persistent high fever (>102.2)

Blood in mucus, or pus in stool

Nonstop vomiting

Orthostatic hypotension- dizziness, cannot acclimate when standing

Severe abdominal pain/ distress

Preexisting conditions, frail, pregnancy

longer than 14 days

Inability of caregiver to rehydrate or suboptimal response to the rehydration

Mild- moderate rehydration options

Rehydrate using oral solution (Pedialyte): 2-4L over 3 hours, then maintenance PRN of ½ to 1 cup per watery bowl movement

Rehydration after with regular dietary fluids if good

Premixed is preferred

Dietary management

Early refeeding+ oral rehydration= improved outcome for kids

Withhold food no more than 24 hrs and begin refeeding 3 to 4 hrs withing oral rehydration

Loperamide

Use for acute, nonspecific diarrhea in patients >6 years or older

Dose- 4mg initially (2 pills), then 2 mg after each loose stool (max of 8 mg/day

48 hour max duration

Patients without high fever and bloody stools

Side effects: dizziness, constipation

Not for bacterial or antibiotic associated

Disc. with distension, constipation or ileus

Bismuth subsalicylate (BSS, Pepto Bismol, Kaopectate)

Reduces frequency of unformed stools, increases stool consistency, relieves abdominal cramping, decreases N/V

Max 48 hour duration

Not for patients less than 18 years of age

SE- mild tinnitus, black tongue or stool

Digestive Lactase Enzyme (Lactaid)

Taken with mild or other dairy products to prevent osmotic diarrhea

Probiotics (EX Lactobacillus species)

Effective in preventing and treating mild acute, uncomplicated diarrhea

Zinc

Suggested to reduce severity, duration, and persistence of diarrhea

Treatment approach for Travelers diarrhea

BSS, loperamide (with antibiotics as needed)

Symptomatic relief of acute, nonspecific diarrhea

loperamide, BSS

Acute gastroenteritis w/ vomiting as primary

BSS- pepto