5 - GI: Diarrhea Flashcards
Epidemiology of Diarrhea
Prevalence HIGHEST in children <5 yo
lowest in adults >65 yo
Etiology of Diarrhea
Poor Sanitation + Hygiene
parasites / bacteria / virus
Day care / food handler / caregiver / close living
Consumption of unsafe foods
Medications / Medical COnditions
EX-ST for Diarrhea
< 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)
Fluid / ELectrolyte Management
for Diarrhea
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
Mild to Moderate
Dehydration / Diarrhea
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
ORT for childrean
1 month to 5 years old
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
ORT for children or adults
>5 years old
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)
Pharmacologic Treatment of
Diarrhea
Loperimide
Imodium A-D
Bismuth Subsalicylate
Pepto Bismol
Loperamide
Indication / MoA
Imodium AD
Opioid agonist
slows motility –> allows for absorption
Used for: Traveler’s Diarrhea / Acute diarrhea / IBD
afibrile or low grade fecer
Loperamide
ADR / DI / Counseling
Imodium
DNU <6 yo
Ab pain / dizziness / constipation
avoid in pt if signs of INVASIVE INFECTION
Bismuth Subsalicylate
MoA / Indications
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
Bismuth Subsalicylate
ADR / DI / Counseling
Pepto Bismol
DNU <12 y/o
Avoid in other viral infections in children
Tinnitus / BLACK STOOL+TONGUE
Aspirin / Warfarin
Valproid Acid / methotrexate
TCA / quinolones
Pepto Bismol for children
ONLY FOR ADULTS AND CHILDREN >12 y/o
- But there is a Children’s Version* (calcium carbonate)
- only treats Heartburn though.*
Diatary Management of
Diarrhea
-
BRATT diet
-
Bananas + Rice + Applesauce + Tea + Toast
- DNU alone or for a long time
-
Bananas + Rice + Applesauce + Tea + Toast
-
Recommend eating:
- Yogurt + Complex carbs / Fruits / Veggies / Lean meats
-
Avoid:
- dairy / fatty foods / spicy foods / simple sugars
- alcohol / caffeine
Diarrhea Recommendations
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
Lactose Intolerance
Epidemiology
Most Common in:
Asians > Native americans
> African
Hispanic > Caucasian
Symptoms after ingestion of
LACTOSE
Ab Pain
Bloating
Flatulence
Diarrhea
bulky / frothy / watery stools
Vomiting in Adolecents
Tips for Lactose Intolerance
Decrease Dietary Lactose
Alternate nutrient sources for energy/protein
Dietary Enzyme Substitute (lactase)
Maintain CALCIUM + VIT D
Lactase
Lactaid
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
Probiotics
Derived from cultured milk products
Help maintain normal GI Flora by:
inhibiting bacterial overgrowth
Role not coclusive
generally safe
Lactobacillus GG
Culturelle
Uses: Mild Viral Diarrhea
in infants/young children
also in some yogurts
for infectious / antibiotic-associated diarrhea
Lactobacillus Acidophilus
Used for Management / prevention of:
Acute uncomplicated diarrhea
Vaginal Infections
Not considered effective by FDA
for infectious / antibiotic associated diarrhea
Bifidobacterium Animalis / Lactis
Activa / Align
Activa / Align
Added to yogurt
to promote intestinal transit / aid in reguarity
Bifidobacterium Infantis
Constipation / Diarrhea / Urgency / Gas / Bloating
Align
Dose & Indication
Bifidobacterium INFANTIS
4mg
1 Capsule Daily
For IBS / Constipation / DIARRHEA /
Nausea & Cramping
Align
ADR / CI / Counseling
Immunocompromised patients
Pregnancy / Lactation LIMITED
Flatulence / Bloating / Diarrhea
Store at ROOM TEMP / has milk products
Culturelle
Dose / Indication
Lactobacills GG
1 Dose Per Day
or BID during digestive upset or travel
14 day course
may be repeated once every
q4 MONTHS
Culturelle
ADR / CI / Counseling
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.
Lactaid
Dose / Indication
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
Lactaid
ADR / CI / Counseling
lactase enzyme
- No known adverse effects*
- See MD if symptoms persist after dairy*
Take with First Bite of dairy foods
Consider supplementing CALCIUM
Loperamide HCL
Dose / Indication
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
Loperimide HCL
MAX Dose
Immodium A-D
Max of 4 Caps (8mg)
or 8 ts
for no more than <2 days
Loperamide HCL
ADR / CI
Immodium AD
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
Loperamide HCL
Consultation
immodium AD
<2 days use
DNU with presence of
HIGH FEVER / BLOODY STOOLS
Prevent dehydration by drinking:
Fluids high in Electrolytes
Avoid Milk
May cause DROWSINESS
Bismuth Subsalicylate
Dose / indication
Pepto Bismol
Tabs / Caps = 262mg
Liquid = 525mg / 30ml
2 tabs (524mg) every hour PRN
or 1 tbps q1hr prn
Bismuth Subsalicylate
MAX Dose
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)
Bismuth Subsalicylate
CI/P / ADR
Pepto Bismol
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
Bismuth Subsalicylate
Consultation
Pepto Bismol
Ask about RX meds
(anticoags / probenecid / sulfinpyrazone)
< 2 Days
Drink fluids w/ electrolytes
Avoid Milk
Harmless darkening of TONGUE / STOOLS
Saccharmomyces
Florastor
Non-pathogenic yeast
250-500mg BID-QID
250 mg bid qid for children
Prevention & Treatment of AB-associated diarrhea
+ travelers diarrhea
