Self Care Diarrhea & Gas

Infectious diarrhea is often self-limiting (symptoms improve

clinically within 24-48 hours)

Initial self-management for adults and children with mild-

moderate, uncomplicated diarrhea should focus on

electrolyte replacement by administering oral rehydration

solutions (ORS) in adequate doses (Pedialyte)

Exclusions for Self-Treatment: Diarrhea

Children with severe hydration

ii. Blood, mucus, or pus in the stool

iii. Protracted vomiting; severe abdominal pain

iv. Pregnancy

go to doctor

Fluid and Electrolyte Management

Rehydration using oral rehydration solutions (ORS) is the

preferred treatment for mild-moderate diarrhea

ii. Electrolytes include: sodium, chloride, citrate, and potassium

iii. Contains low concentrations of glucose/dextrose (2-2.5%);

provide little caloric support but facilitates intestinal sodium and

water absorption

Carried out in two phases: rehydration and maintenance therapy

1. Rehydration: over three to four hours

quickly replaces water and electrolyte deficits

2. Maintenance: electrolyte solutions are

given to maintain normal body composition until dietary

intake is reestablished

Rehydration & Maintenance OTC options

Pedialyte, Pedialyte Freezer Pops,

Enfamil Enfalyte Solution, CeraLyte Powder Packets (no evidence

that one product is superior to another)

Pedialyte

infants under 1 - consult doctor

for children 1 year or older and adults - begin small frequent sips every 15 min, increasing as tolerated, continue as long as diarrhea present

to maintain hydration 1 -2 liters a day

Pharmacologic Treatment

a. Loperamide

b. Bismuth subsalicylate

c. Digestive enzymes

Loperamide

Dosage Forms: Caplets (2 mg), Liquid (1 mg/7.5 mL)

Adult Dosage: 4 mg initially, then 2 mg after each loose stool. Do not exceed 8 mg/day

Pediatric Dosage: Not recommended for children < 6 years of age (med. supervision only)

Duration: 48 hours

Bismuth

Subsalicylate

Dosage Forms: Tablets (262 mg), Caplets (262 mg), Liquids (262 mg/15 mL)

Adult Dosages: 525 mg every 30-60 minutes up to 4200 mg/day Max: 8 doses/day

Pediatric Dosages: Not recommended for children < 12 years of age (med. supervision only)

Duration: 48 hours

Digestive

enzymes

Dosages Forms: Chewable tablets, caplets, liquids

Adult Dosages: 5-15 drops placed in or taken with dairy product; 1-3 tabs or 1-2 caps with 1st bite of dairy product

Pediatric Dosage: Same as adult dosage

Duration: Take with each consumption of dairy product

Loperamide (Imodium®)

A synthetic opioid agonist that lacks CNS effects; stimulates opioid

receptors on the intestinal muscles to slow intestinal motility and allows

absorption of electrolytes and water; Abuse potential

b. Effective antidiarrheal agent in traveler’s diarrhea

c. Few side effects include occasional dizziness and constipation, abdominal

pain/distention, dry mouth

d. Products include: Imodium® A-D (loperamide caplets and liquid) and

Imodium® Advanced Formula Caplets (loperamide and simethicone)

Bismuth Subsalicylate (Pepto-Bismol®, Kaopectate®)

Reacts with hydrochloric acid in the stomach to form bismuth oxychloride

and salicylic acid - component of aspirin

i. Both of these moieties are pharmacologically active

1. Bismuth exerts antimicrobial effects

2. Salicylate exerts anti-secretory effects that reduce fluid

and electrolyte losses

ii. Reduce the frequency of unformed stools, increase stool

consistency, decrease N/V, and relieve symptoms of abdominal

cramping

Bismuth Subsalicylate (Pepto-Bismol®, Kaopectate®) Adverse effects include:

Effective antidiarrheal agent in traveler’s diarrhea; also used to treat

Helicobacter pylori—associated with peptic ulcer disease

c. If a patient is taking aspirin or other salicylate containing

drugs, toxic levels of salicylate may be reached

i. Mild tinnitus (dose related)

ii. Reye’s Syndrome (especially children and adolescents with

chicken pox or flu symptoms)

iii. Harmless black staining of stool or tongue

1. Bismuth reacts with hydrogen sulfide produced by bacteria

in the mouth and colon

Avoid in patients who are sensitive to aspirin (bronchospasm)

e. Drug interactions include those agents that potentially interact with

aspirin (warfarin, valproic acid, methotrexate, tetracyclines, quinolones)

Children’s Pepto® Antacid

contains calcium carbonate 400 mg and is

not associated with Reye’s syndrome; not labeled for treatment of

diarrhea

Digestive Enzymes

For patients with lactase deficiency who are intolerant of milk products

b. Taken with milk or dairy products to prevent diarrhea

c. Products include: Lactaid® (caplets, chewable tablets), Lacteez® Drops,

and Lactrase® Capsules

gas, bloating, diarrhea

Special Populations

For young children (5 years and younger), self-treatment is limited to

treating dehydration with ORS; antidiarrheal medications are not

recommended

b. Elderly patients (65 years and older) should be strongly cautioned against

self-treatment with antidiarrheal medications; more likely to be severe or

possibly fatal

c. Use of OTC anti-diarrhea medications may be inappropriate during

pregnancy; refer these patients

ORS should be used to

rehydrate patients (especially children) with

minimal or mild-moderate dehydration

Loperamide and bismuth may be used to

help control acute diarrhea in

carefully selected patients

Simethicone (Gas-X®, Mylanta® Gas Chewable Tablets, Mylicon® Infant’s

Drops)

Relieve symptoms after intestinal gas has formed

ii. Used as a defoaming agent; acts in stomach and intestine to

reduce surface tension of gas bubbles that are in GI tract

1. NOT absorbed from GI tract therefore no systemic side

effects; its safety is well documented

iii. Safe and effective agent for all ages

Safest drug OTC -no drug interactions

Alpha-galactosidase (Beano®)

i. Taken with foods to prevent gas from forming

ii. Recommended as a prophylactic treatment of intestinal gas

symptoms produced by high-fiber diets or foods such as

vegetables, grains, and beans

iii. Produces galactose, therefore use in caution with

diabetic patients since 2-6 grams of carbohydrates is produced

(per 100 grams of food)

Lactase enzyme (Lactaid®, Lactase®, Lactrase®, Lacteeze® Drops)

Taken with foods to prevent gas from forming

ii. Beneficial for the treatment of intestinal gas and diarrhea

associated with lactose intolerance; no adverse effects listed for

these products

Probiotics (Activia® Probiotic Yogurt, Align® Digestive Care Probiotic

Supplement, Culturelle® Probiotic Digestive Health, FloraQ®, Florastor®)

Maintain GI health by protecting against pathologic GI flora

ii. Increasing evidence that probiotics may be beneficial for gas

symptoms in patients with IBS and lactose intolerance

Simethicone is NOT absorbed from the GI tract, and it is

considered safe

for use in infants and children

i. Several pediatric formulations contain 40 mg per 0.6 mL and are

promoted to relieve gas associated with colic

Patients with diabetes should

avoid alpha-galactosidase since it produces

carbohydrates; use simethicone instead

Alpha-galactosidase and lactase replacement products are used to

prevent the onset of symptoms in patients unable to tolerate

problematic foods; patients with gas symptoms who need immediate

relief should use simethicone

Probiotics may be

helpful for patients with IBS and lactose intolerance

who experience bloating and gas