[07.13] Drugs for Motility, Laxatives, and Anti-Diarrheal Drugs V2.1.pdf

9%

What percentage of total deaths among children under 5 years old globally is accounted for by diarrhea?

Food and water-borne diseases (FWBDs)

What public health problem usually manifests as diarrhea and constitutes a growing global concern?

Rising

What is the trend for acute bloody diarrhea (ABD) cases in the Philippines according to 2015 sentinel site data?

Acute watery diarrhea

Which type of diarrhea saw a decrease in cases in the Philippines between 2013 and 2015 compared to 2011-2012?

Less than 14 days

What is the maximum duration for a condition to be classified as acute diarrhea?

Three or more

How many loose watery or bloody stools must be passed within a 24-hour period to meet the definition of acute diarrhea?

Immunocompetent

Acute diarrhea definition specifically applies to what type of person relative to their normal baseline?

Acute infectious diarrhea

What is the term for acute diarrhea accompanied by nausea, vomiting, abdominal pain, and fever caused by agents like bacteria or viruses?

Duration and frequency

When a patient presents with diarrhea, what are the first two questions a clinician should ask to assess severity?

Small intestine

Diarrhea that is typically watery, voluminous, and associated with abdominal cramps and gas likely originates where?

Secretory or osmotic

What are the two primary natures of voluminous diarrhea originating in the small intestine?

Large intestine

Diarrhea that is smaller in volume, more frequent, and mucoid or bloody likely originates where?

Inflammatory

What is the typical nature of diarrhea originating in the large intestine?

Distal portions of the colon or rectum

Which anatomical structures attempt to empty themselves, leading to the high frequency of stools in large intestine diarrhea?

Rotavirus and Vibrio cholerae

Watery stool is common in diarrhea caused by which two specific etiologic agents?

Shigella and Salmonella

Bloody stool is common in diarrhea caused by which two specific etiologic agents?

Salmonella

Which causative agent is associated with food-borne outbreaks, poultry, eggs, and mayonnaise?

Shiga-toxigenic E. coli (STEC)

Which agent is associated with beef and raw seed sprouts like alfalfa?

Vibrio sp.

What agent is commonly transmitted through water, seafood, and shellfish?

Giardia intestinalis and Cryptosporidium

Name two parasites associated with water-borne transmission and poultry/pies.

Norovirus

Which virus is a common cause of diarrhea associated with seafood and shellfish?

Campylobacter

Which bacterium is a common cause of diarrhea from poultry and pies?

Staphylococcus

Which agent is associated with mayonnaise and cream and has an incubation period of less than 6 hours?

Clostridium difficile

Which agent is specifically associated with the use of antibiotics or chemotherapy?

Shigella and Rotavirus

Which two agents are commonly spread through person-to-person transmission?

Pre-formed toxins

What is the specific culprit for food intoxication that manifests in less than 6 hours, such as in S. aureus infections?

16 - 72 hours

What is the incubation period for Noroviruses, ETEC, Salmonella, and Shigella?

Not indicated

Is routine stool examination typically indicated for acute watery diarrhea?

Bloody diarrhea or suspected parasitism

List two scenarios where a routine stool examination would be indicated.

High risk of transmission (e.g., food handler)

Stool cultures are indicated in severe cases or for individuals in what specific high-risk category?

Respiration and Skin pinch

Besides condition and thirst, what are two key parameters used to assess dehydration in children?

Two or more

How many signs from a specific category in the dehydration master table are required to diagnose mild, moderate, or severe dehydration?

Altered consciousness, abdominal distension, and respiratory distress

List three physical findings that are criteria for admitting a child with diarrhea.

Hypothermia (<36°C)

What temperature finding is a criterion for admitting a child with diarrhea?

Pneumonia, Meningitis, and Sepsis

What three co-existing infections warrant the admission of a child with diarrhea?

Hematocrit

Which specific component of a CBC can indicate hypovolemia and dehydration if it is high?

Specific gravity

What should be checked in a urinalysis to determine if urine is concentrated due to dehydration?

Hyponatremia and hypokalemia

What are the two most common electrolyte imbalances produced by diarrhea?

Blood Urea Nitrogen (BUN) and Creatinine

The rise of which two serum markers indicates acute kidney injury as a complication of diarrhea?

Metabolic acidosis

What is a dreadful complication of acute infectious diarrhea caused by the external loss of bicarbonate?

Rehydration therapy

What remains the primary management of acute infectious diarrhea in children?

NOT recommended

What is the stance on routine empiric antibiotic therapy for children with diarrhea?

ORS after each loose stool

If a child shows no signs of dehydration, how should ongoing losses be replaced?

50-100 mL

How much ORS should be given after each loose stool to a child under 2 years old with no signs of dehydration?

100 mL

How much ORS should be given after each loose stool to a child aged 2-10 years old?

75 mL/kg over 4 hours

For a child with mild to moderate dehydration, how much ORS should be given initially?

Nasogastric tube (NGT)

If a child does not tolerate oral ORS, what is the next recommended route of administration?

Lactated Ringer's (LR) or 0.9% NaCl (NSS)

If NGT administration is not possible, which two IV fluids are used for pediatric rehydration?

Up to two cycles

How many treatment cycles should be attempted if rehydration is not initially successful?

Reduced osmolarity ORS

Which type of ORS reduces the amount of vomiting, the need for IV fluids, and stool secretion?

Glucose and Sodium

Standard WHO ORS has higher concentrations of which two components compared to the New WHO Reduced Osmolarity ORS?

1 liter clean water, 3g salt, 18g sugar

What are the ingredients and amounts for making home-made ORS?

Isotonic

What type of fluids, such as NSS and LRS, have an osmolarity similar to solutes in the blood?

Lactated Ringer's (LR)

Which IV fluid contains lactate to aid in correcting metabolic acidosis?

Potassium

Lactated Ringer's is noted for having a low concentration of which electrolyte?

Dextrose

The addition of what substance makes an IV solution hypertonic, such as D5LR or D5NS?

Dilutional hyponatremia

What is the risk of using hypotonic solutions (like 0.45% NaCl) in severe dehydration when ADH is present?

1 hour (30 mL/kg) and 5 hours (70 mL/kg)

For an infant under 12 months with severe dehydration, what is the timeline for administering 100 mL/kg of IV fluid?

30 minutes (30 mL/kg) and 2.5 hours (70 mL/kg)

For a child over 12 months with severe dehydration, what is the timeline for administering 100 mL/kg of IV fluid?

Holliday-Segar Method

Which weight-based method is commonly used to compute maintenance fluid requirements?

100 mL/kg

According to the Holliday-Segar method, what is the fluid requirement for a child weighing 0-10 kg?

1,000 mL + 50 mL/kg for each kg over 10 kg

What is the maintenance fluid requirement for a child weighing 11-20 kg?

20 mEq KCl/L

Once a child starts urinating during IV hydration, what should be added to the fluid?

Cholera, bloody diarrhea, and co-existing acute infections

List three conditions where antimicrobials are recommended for children.

Azithromycin and Doxycycline

What are the two primary drugs for treating Cholera in children?

Ceftriaxone and Ciprofloxacin

What are the two primary drugs for treating Shigella in children?

Not recommended

What is the recommendation for antibiotic use in children with Non-typhoidal Salmonella (NTS) who are not high-risk?

Metronidazole

Which drug is the treatment of choice for Amoebiasis?

Reduces duration and severity

What is the major role of Zinc in diarrhea management?

20 mg/day for 10-14 days

What is the dosage and duration for Zinc supplementation as an adjunct therapy for children >6 months?

50%

Zinc supplementation can reduce non-accidental deaths by as much as what percentage?

Inhibits potassium (K+) channels

Zinc inhibits cAMP-induced fluid secretion by specifically inhibiting which structures?

Magnesium

All children with persistent diarrhea should receive supplementary multivitamins including which specific mineral?

4 hours

The practice of withholding food for longer than how many hours is considered inappropriate?

Inadequate nutritional value

Why is the BRAT diet (banana, rice, apple, tea) NOT recommended for children?

Adults only

Antiemetics are recommended for which patient population in the context of diarrhea?

Draws out fluid (osmotic effect)

Why should soda and Gatorade generally be avoided for diarrhea patients?

Strain-specific

Probiotics can help manage diarrhea, but their effects are described as being what?

Lactobacillus casei Shirota strain

What is the scientific name of the probiotic strain found in Yakult?

Probiotic

What term describes live microorganisms that confer a health benefit when administered in adequate amounts?

Prebiotic

What term describes a selectively fermented ingredient that results in specific changes in the gut microbiota?

Synbiotic

What term describes products that contain both probiotics and prebiotics?

1 day

Oral administration of probiotics can shorten the duration of acute diarrheal illness in children by approximately how long?

Bacillus clausii

Which probiotic is sold under the brand name Erceflora?

Secretory IgA

Probiotics enhance immunologic defense by increasing the production of which antibody locally and systemically?

Bacteriocins

Probiotics can produce which substances to inhibit the growth of pathogens?

Lactulose

Which prebiotic is a synthetic disaccharide used to treat constipation and hepatic encephalopathy?

Acidifies colonic contents to ionize NH3 into NH4

What is the mechanism of action of Lactulose in treating hepatic encephalopathy?

Short-chain fatty acids

One metabolic effect of prebiotics is the production of what?

Outpatient with volume/volume ORS

If an adult patient has no signs of severe dehydration and can meet needs enterally, how are they managed?

Systolic BP

What are the first two indicators for aggressive fluid resuscitation in adults?

Capillary refill >2 seconds and RR >20 cpm

What are the third and fourth indicators for aggressive fluid resuscitation in adults?

Plain Lactated Ringer's Solution (PLRS)

What is the preferred IV fluid for aggressive resuscitation in adults?

500 - 1,000 mL Fast Drip

What is the resuscitation dose for an adult with moderate dehydration?

1,000 - 2,000 mL Fast Drip

What is the resuscitation dose for an adult with severe dehydration?

Pulmonary crackles

During fast drip resuscitation, clinicians must check for signs of congestion, such as what?

2 - 3 mL/kg/hr

What is the maintenance IV fluid rate for an adult weighing less than 50 kg?

1.5 - 2 mL/kg/hr

What is the maintenance IV fluid rate for an adult weighing more than 50 kg?

Azithromycin (1g single dose) or Ciprofloxacin (500mg BID)

What are the two drug options for empiric antimicrobial treatment in adults?

Bloody diarrhea, high fever, or systemic toxicity

In what three adult conditions should non-specific antidiarrheal treatments NOT be used?