Diarrhea Lecture Notes

Flashcards about Diarrhea

Diarrhea

Passage of abnormally liquid or unformed stools at an increased frequency.

Signs and symptoms of Diarrhea

Bowel movements are frequent and diarrhea lasts 12 to 60 hours; Lower right quadrant pain with cramps

Laboratory tests for Diarrhea

Stool analysis studies include examination for microorganisms, blood, mucus, fat, osmolality, pH, electrolyte and mineral concentration, and cultures.

Common causes of Diarrhea

Infections with viruses, bacteria, or protozoa; common bacteria include Shigella, Salmonella, Campylobacter, Staphylococcus, and E coli; Acute viral infections are generally caused by Norwalk and rotavirus; poor sanitary conditions; travel to an endemic region

Drugs that can cause Diarrhea

Antacids containing magnesium, antineoplastics, clindamycin, tetracyclines, sulfonamides, any broad-spectrum antibiotic, digoxin, misoprostol, colchicine, proton pump inhibitors, H2-receptor blockers, laxatives

Treatment for Diarrhea

Fluid and electrolyte replacement; Oral sugar-electrolyte solutions should be started in severe diarrhea to limit dehydration; antimotility agent such as loperamide

Treatment Goals for Diarrhea

Manage diet; Prevent fluid/electrolyte disturbance; Relieve symptoms; Treat underlying cause; Manage secondary disorders

Loperamide (Imodium)

Acts only peripherally; MOA: Antisecretory; inhibits the calcium-binding protein calmodulin, and controls chloride secretion

Loperamide Usual adult dose

4 mg orally, followed by 2 mg after each loose stool, up to 16 mg/day.

Loperamide Side effects

dizziness and constipation

Loperamide Box Warning

Torsades de pointes and sudden death have been reported with the use of a higher than recommended dosage of loperamide; Loperamide is contraindicated in pediatric patients <2 years of age.

Diphenoxylate-atropine (Lomotil)

Centrally and peripherally acting opioid derivative

reason for atropine in Diphenoxylate-atropine (Lomotil)

to counteract the potential for opioid abuse and CNS effects.

Diphenoxylate-atropine (Lomotil) contraindications

this medication used to treat diarrhea should not be used for patients at risk if bacterial enteritis with E. coli, Salmonella, or Shigella

Atropinism

blurred vision, dry mouth, and urinary hesitancy

Adsorbents

Used for symptomatic relief; MOA: They adsorb nutrients, toxins, drugs, and digestive juices

Polycarbophil

Absorbs 60 times its weight in water and can be used to treat both diarrhea and constipation

Bismuth subsalicylate (Pepto Bismol)

has some antisecretory, anti-inflammatory, and antibacterial effects

Bismuth subsalicylate Indications:

Indigestion, relieving abdominal cramps, and controlling diarrhea, including traveler’s diarrhea and infectious diarrhea.

Bismuth subsalicylate Usual Adult Dose

Two tablets or 30 mL every 30 minutes to 1 hour up to eight doses per day.

Bismuth subsalicylate DDI

The active ingredient is salicylate, which may interact with anticoagulants or may produce salicylism (tinnitus, nausea, and vomiting). Bismuth reduces tetracycline absorption

Bismuth subsalicylate ADRs

Darkening of the tongue and stools with repeat administration. Salicylate can induce gout attacks in susceptible people.

Possible causes of Diarrhea

Intestinal infections (bacterial or protozoal); Inflammatory disease (Crohn’s disease or ulcerative colitis), Malabsorption (lactose intolerance) Secretory hormonal tumor (intestinal carcinoid tumor or Vasoactive intestinal peptide-secreting tumor [VIPoma]); medications; Motility disturbance (diabetes mellitus, irritable bowel syndrome, or hyperthyroidism).

Acute diarrhea

Less than 14 days?duration

Chronic diarrhea

More than 14 days? duration.

Probiotics

Microorganisms given to reestablish normal colonic microflora.

Lactase enzyme products

Helpful for patients who are experiencing diarrhea secondary to lactose intolerance.