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PDAT1 > 5 - GI: Diarrhea > Flashcards

5 - GI: Diarrhea Flashcards

1
Q

Epidemiology of Diarrhea

A

Prevalence HIGHEST in children <5 yo

lowest in adults >65 yo

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2
Q

Etiology of Diarrhea

A

Poor Sanitation + Hygiene

parasites / bacteria / virus

Day care / food handler / caregiver / close living

Consumption of unsafe foods

Medications / Medical COnditions

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3
Q

EX-ST for Diarrhea

A

< 6 months old

SEVERE DEHYDRATION HIGH FEVER >102.2F

PREGNANCY

blood / mucus / pus / protracted VOMIT

Severe ab pain / risk for complications w/ disease

chronic / persistant diarrhea

Inability to take ORT (or poor response to ORT)

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4
Q

Fluid / ELectrolyte Management

for Diarrhea

A

ORAL REHYDRATION THERAPY (ORT)

glucose / sodium / chloride / citrate / potassium

Recommended in Mild-Moderate Diarrhea

as effective as IV replacement in children

Lower Osmolarity vs

electrolyte dextrose drinks (gatorade

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5
Q

Mild to Moderate

Dehydration / Diarrhea

A

3 - 9 % loss of body weight

Fatigued / restless / irritable

normal to increased HEART RATE

  • normal to decreased pulse quality*
  • decreased tears / urine output*

cool extremeties / thirsty

_<_5 unformed stools per day

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6
Q

ORT for childrean

1 month to 5 years old

A

50-100 ml/kg

over 3-4 hours

10ml/kg per each loose stool

Maintanance:

Continue ORT for 4-6 hours until rehydrated

resume normal eating

Ideally 3:1 ratio of glucose to sodium

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7
Q

ORT for children or adults

>5 years old

A

2-4L

over 3-4 hours

Replace losses

Maintanence:

Continue ORT PRN

normal diet

Symptomatic Drug Therapy

Gatorade is 15:1 ratio (lot of water)

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8
Q

Pharmacologic Treatment of

Diarrhea

A

Loperimide

Imodium A-D

Bismuth Subsalicylate

Pepto Bismol

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9
Q

Loperamide

Indication / MoA

A

Imodium AD

Opioid agonist

slows motility –> allows for absorption

Used for: Traveler’s Diarrhea / Acute diarrhea / IBD

afibrile or low grade fecer

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10
Q

Loperamide

ADR / DI / Counseling

Imodium

A

DNU <6 yo

Ab pain / dizziness / constipation

avoid in pt if signs of INVASIVE INFECTION

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11
Q

Bismuth Subsalicylate

MoA / Indications

A

Pepto Bismol

Reacts w/ HCL –> bismuth oxycholride + salicylic acid

ANTIMICROBIAL EFFECTS OF BISMUTH

  • Reduces freq of unformed stools*
  • Relives ab cramp*
  • decrease nausea + vomiting*

Used for Acute Diarrhea / Traveler’s Diarrhea

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12
Q

Bismuth Subsalicylate

ADR / DI / Counseling​

Pepto Bismol

A

DNU <12 y/o

Avoid in other viral infections in children

Tinnitus / BLACK STOOL+TONGUE

Aspirin / Warfarin

Valproid Acid / methotrexate

TCA / quinolones

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13
Q

Pepto Bismol for children

A

ONLY FOR ADULTS AND CHILDREN >12 y/o

  • But there is a Children’s Version* (calcium carbonate)
  • only treats Heartburn though.*
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14
Q

Diatary Management of

Diarrhea

A
  • BRATT diet
    • ​Bananas + Rice + Applesauce + Tea + Toast
      • DNU alone or for a long time
  • ​​Recommend eating:
    • Yogurt + Complex carbs / Fruits / Veggies / Lean meats
  • ​Avoid:
    • ​dairy / fatty foods / spicy foods / simple sugars
    • alcohol / caffeine
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15
Q

Diarrhea Recommendations

A

FLUID INTAKE is important

SEE MD if on OTC meds for >48 Hours

Most diarrhea is SELF LIMITING

(use non-pharm treatment first)

Double check active ingredients

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16
Q

Lactose Intolerance

Epidemiology

A

Most Common in:

Asians > Native americans

> African

Hispanic > Caucasian

17
Q

Symptoms after ingestion of

LACTOSE

A

Ab Pain

Bloating

Flatulence

Diarrhea

bulky / frothy / watery stools

Vomiting in Adolecents

18
Q

Tips for Lactose Intolerance

A

Decrease Dietary Lactose

Alternate nutrient sources for energy/protein

Dietary Enzyme Substitute (lactase)

Maintain CALCIUM + VIT D

19
Q

Lactase

Lactaid

A

Digestive Enzyme

don’t completely hydrolyze all dietary lactose

Liquid Lactaid can be added to milk

14 drops -> 1 quart

Refrigerate overnight

Adjust dose and lactose load to tolerance

20
Q

Probiotics

A

Derived from cultured milk products

Help maintain normal GI Flora by:

inhibiting bacterial overgrowth

Role not coclusive

generally safe

21
Q

Lactobacillus GG

Culturelle

A

Uses: Mild Viral Diarrhea

in infants/young children

also in some yogurts

for infectious / antibiotic-associated diarrhea

22
Q

Lactobacillus Acidophilus

A

Used for Management / prevention of:

Acute uncomplicated diarrhea

Vaginal Infections

Not considered effective by FDA

for infectious / antibiotic associated diarrhea

23
Q

Bifidobacterium Animalis / Lactis

Activa / Align

A

Activa / Align

Added to yogurt

to promote intestinal transit / aid in reguarity

24
Q

Bifidobacterium Infantis

A

Constipation / Diarrhea / Urgency / Gas / Bloating

25
Q

Align

Dose & Indication

A

Bifidobacterium INFANTIS

4mg

1 Capsule Daily

For IBS / Constipation / DIARRHEA /

Nausea & Cramping

26
Q

Align

ADR / CI / Counseling

A

Immunocompromised patients

Pregnancy / Lactation LIMITED

Flatulence / Bloating / Diarrhea

Store at ROOM TEMP / has milk products

27
Q

Culturelle

Dose / Indication

A

Lactobacills GG

1 Dose Per Day

or BID during digestive upset or travel

14 day course

may be repeated once every

q4 MONTHS

28
Q

Culturelle

ADR / CI / Counseling

A

Lactobaccillis GG

Immunocompromised patients

Pregnancy / Lactation limited

flatuelence / bloating / diarrhea

CAPSULE MAY BE OPENED AND MIXED WITH

COOL DRINK OR FOOD

do NOT add to WARM OR HOT foods/drink

store in cool place / room temp.

29
Q

Lactaid

Dose / Indication

A

Lactase Enzyme

Original Caplet = 3000FCC

Fast Act = 9000FCC

To help prevent GAS / BLOATING / DIARRHEA

9000 FCC (1 or 3 capsules)

with the FIRST BITE OF DAIRY FOODS

30
Q

Lactaid

ADR / CI / Counseling

lactase enzyme

A
  • No known adverse effects*
  • See MD if symptoms persist after dairy*

Take with First Bite of dairy foods

Consider supplementing CALCIUM

31
Q

Loperamide HCL

Dose / Indication

A

Imodium A-D (anti DIARRHEA)

Caps = 2mg vs Liquid = 1mg / 7.5ml

2 Caps (4mg) or 4 ts

AFTER FIRST LOOSE BOWEL MOVEMENT

1 Cap (2mg) or 2 ts

After each subsequent loose bowel movement

max 4 caps, <2 days

32
Q

Loperimide HCL

MAX Dose

A

Immodium A-D

Max of 4 Caps (8mg)

or 8 ts

for no more than <2 days

33
Q

Loperamide HCL

ADR / CI

Immodium AD

A

use only for < 2 days

  • Do not use if diarrhea is with HIGH FEVER / BLOODY STOOLS*
  • caution with hepatic dysfunction*
  • DNU w/ Ulcerative Colitis*

or diarrhea from E.Coli / Salmonella / Shigella

Constipation / Dry Mouth / Nausea / Vomiting

34
Q

Loperamide HCL

Consultation

immodium AD

A

<2 days use

DNU with presence of

HIGH FEVER / BLOODY STOOLS

Prevent dehydration by drinking:

Fluids high in Electrolytes

Avoid Milk

May cause DROWSINESS

35
Q

Bismuth Subsalicylate

Dose / indication

A

Pepto Bismol

Tabs / Caps = 262mg

Liquid = 525mg / 30ml

2 tabs (524mg) every hour PRN

or 1 tbps q1hr prn

36
Q

Bismuth Subsalicylate

MAX Dose

A

Pepto Bismol

2 tab (524mg) q1hr PRN

Max dose of:

8 Doses / day

(16 tabs of 262mg tabs)

4 Doses of extra strength (525mg tabs)

37
Q

Bismuth Subsalicylate

CI/P / ADR

Pepto Bismol

A

High Fever + Bloody Stools

REYE SYNDROME (children w/ flu)

ALLERGIC TO: ASA

Asthma / Ulcers / Bleeding

Stomach Pain / Gout / Diabetes

BLOOD THINNERS

TEMPORARY DARKENING OF TONGUE OR STOOLS

38
Q

Bismuth Subsalicylate

Consultation

Pepto Bismol

A

Ask about RX meds

(anticoags / probenecid / sulfinpyrazone)

< 2 Days

Drink fluids w/ electrolytes

Avoid Milk

Harmless darkening of TONGUE / STOOLS

39
Q

Saccharmomyces

Florastor

A

Non-pathogenic yeast

250-500mg BID-QID

250 mg bid qid for children

Prevention & Treatment of AB-associated diarrhea

+ travelers diarrhea

PDAT1 (27 decks)

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