3. Diarrhoea

Question 1

Diarrhoea

Answer 1

Passing loose stools with increased frequency and volume

Rotavirus, noravirus are common causes in children
IBS, IBD, Food poisoning can also cause diarrhoea

Question 2

Diarrhoea symptoms

Answer 2

Symptoms:

• Frequent watery stools
• Dehydration

Question 3

Diarrhoea red flag symptoms

Answer 3

• Unexplained weight loss
• Rectal bleeding
• Persistent diarrhoea
• Sytsemic illness
• Recent hospitalisation
• Antibiotics (antibiotic-associated colitis)
• Foreign travel

Question 4

Diarrhoea treatment

Answer 4

Oral rehydration salts:
Contain glucose, rice powder, Na+, K+

Antidiarrhoeals:
Loperamide (preferred)
Codeine
Kaolin
Kaolin with morphine
Methylcellulose

Question 5

Loperamide mechanism of action

Answer 5

Binds to opioid receptors in the gut wall and reduces gut motility to increase transmit time

Question 6

Loperamide dose

Answer 6

4mg straight away, followed by 2mg after loose stools for 5 days

NOT recommended in those under 12 years

Question 7

Loperamide contra-indications

Answer 7

Colitis
e.g acute ulcerate colitis –> toxic megacolon,
e.g antibiotic-associated infections as it slows down the body’s ability to eliminate toxic bacteria

Contraindictaed in conditons that are worsened by inhibiting peristalsis, e.g ascites

Question 8

Loperamide side effects

Answer 8

• Dizziness, Flatulence
• Headache
• Nausea

MHRA alert: serious cardiac adverse reactions with high-doses such as QT prolongation, torsades de pointes, cardiac arrest
Patients must be reminded of the dose. If there is an overdose, naloxone must be provided