Acute Diarrhea Flashcards
Acute diarrhoea is that which lasts less than ________________, but symptoms usually improve within ______________.
14 days
2–4 days
What are the common causes of diarrhea? (6)
- Infection
- Side effect of a drug
- Acute symptom of a chronic GI disorder (IBS, IBD)
- Accumulation of non-absorbed osmotically active solutes in the GI lumen (eg lactase deficiency)
- GI effects of secretory stimuli (other than enterotoxins from infection)
- Intestinal motility or morphology disorders
What are the red flags of diarrhea? (6)
- Unexplained weight loss
- Rectal bleeding
- Persistent diarrhea
- Systemic illness
- Recent hospital treatment or antibiotics
- Following foreign travel
What are the aims of treatment in a patient with acute diarrhea? (2)
- Prevent or reverse fluid and electrolyte depletion
- Management of dehydration if present
*particularly important in infants, frail, and elderly patients when electrolyte loss and dehydration can be life-threatening
What is the preferred treatment of acute diarrhea in most cases?
Most episodes will settle spontaneously without the need for any medical treatment
Oral rehydration therapy (ORT) to prevent or correct diarrhea dehydration and maintain appropriate fluid intake once rehydration is achieved
What is the management of patients with acute diarrhea who are severely dehydrated or unable to drink?
Immediate admission to hospital and urgent fluid replacement with IV rehydration fluid
Which drug is used as first line treatment when rapid control of diarrhea symptoms is required?
Loperamide
Can also be used for mild-to-moderate travellers’ diarrhea (eg where toilet amenities are limited or unavailable)
Loperamide should be avoided in patients with which symptoms? (3)
- Bloody diarrhea
- Suspected inflammatory diarrhea (febrile patients)
- Significant abdominal pain (which also suggests inflammatory diarrhea)
_____________ is also the first line treatment for patients with fecal incontinence (unlicensed) after underlying causes of incontinence have been addressed
Loperamide
Racecadotril is licensed as an adjunct to ________________ for the symptomatic treatment of uncomplicated acute diarrhoea in adults and children over 3 months.
rehydration
______________ is licensed as an adjunct to rehydration for the symptomatic treatment of uncomplicated acute diarrhoea in adults and children over 3 months.
Racecadotril
What is the mechanism of action of loperamide?
Trade name: Imodium
Drug class: opioid agonist, also inhibits the effects of calmodulin
Acts by slowing intestinal motility and by affecting water and electrolyte movement through the bowel
What is the mechanism of action of racecadotril?
Peripheral enkephalinase inhibitor (enkephalins are endogenous opioids, thus drug leads to an increase in their number and effect); reduces hypersecretion of water and electrolytes in the intestinal lumen
*unlike loperamide, which reduces intestinal lumen motility
________________ is occasionally used for prophylaxis against travellers’ diarrhoea, but routine use is not recommended
Ciprofloxacin
_______________ is used to treat travellers’ diarrhea (that is not associated with fever, bloody diarrhea, blood or leucocytes in stool, or 8 or more unformed stools in the previous 24 hours) AND in the treatment of hepatic encephalopathy to reduce recurrence
Rifaximin
How does rifaximin help prevent recurrence of hepatic encephalopathy?
Rifaximin is a minimally absorbed antibiotic and exhibits its effects by reducing ammonia production in the colon via the elimination of ammonia-producing bacteria
Can rifaximin be used to treat systemic infections?
Not well absorbed by the gut so NOT effective in treating systemic infections
Serious ________________ events, including fatalities, have been reported in association with large overdoses of loperamide.
cardiovascular (such as QT prolongation, torsades de pointes, and cardiac arrest)
If symptoms of overdose occur with administration of loperamide, ______________ can be given as an antidote
Naloxone
The duration of action of loperamide is longer than that of naloxone (1–3 hours), so repeated treatment with naloxone might be indicated; patients should be monitored closely for at least 48 hours to detect possible CNS depression
What are the contraindications to using loperamide? (5)
- Active UC
- Abx-associated colitis
- Bacterial enterocolitis
- Conditions where abdominal distension develops
- Conditions where inhibition of peristalsis should be avoided
*not recommended for children under 12
Is loperamide safe to prescribe in patients with hepatic and/or renal impairment?
Caution in hepatic impairment due to risk of reduced first pass metabolism leading to CNS toxicity
Because loperamide is an opioid, side effects may include…? (4)
- Nausea and vomiting
- Drowsiness and impaired consciousness
- Miosis
- Urinary retention
