Diarrhea Flashcards
What is the bristol stool chart indication for diarrhea?
type 5, 6 or 7
How is diarrhea defined and what is the difference between acute and chronic?
3 or more loose or watery stools in 24 hours
Acute = 14 days or less Chronic = more than 28 days
What is the difference in the pathophysiology of osmotic versus peristaltic versus secretory diarrhea?
Osmotic: osmotically-active solutes present in the gut limen decrease the osmotic gradient and water absorbtion
**improves with fasting –> good to differentiate
Peristaltic: stimulation of enteric nervous system increase peristalsis and decrease time for water absorption
**can be caused by stress, caffeine and abrupt cessation of opioids
Secretory: ion transport across intestinal membrane is reversed which decreases osmotic gradient and water absorption (so much so that it may actually pull in water)
**likely a viral or bacterial infection
What are some possible dietary triggers of diarrhea?
- alcohol
- caffeine
- fructose
- lactose
- sorbitol
What are some of the possible medication triggers of diarrhea?
- SSRIs
- NSAIDs
- Lithium
- Antibiotics
- ACE inhibitors
- Anticoagulants
- PPIs
How can you prevent infectious diarrhea?
- drink and use clean, safe water
- follow hand hygiene guidelines
- practice food safety (expiration dates, wash fruits/veg, cook meat thoroughly, keep separate from other foods)
What are the red flags for a patient presenting with diarrhea?
Anything that indicates it is non-infectious or non-self limiting:
- high fever (above 38.5)
- diarrhea >14 day duration
- worsening
- blood or mucus in stool
- weight loss or dehydration due to diarrhea
- immunocompromised
- severe pain/cramping
- recent use of antibiotics
High risk of complications:
- pregnancy
- frail and elderly
- vomiting >4 hours
- diabetes, heart failure or chronic kidney disease
- severe diarrhea (>6 episodes/day >48 hours)
What is hypovolemia and hypervolemia?
Terms used when assessing fluid status; intravascular vs total body fluid contents
Hypovolemia: poor fluid intake, excessive fluid loss
Hypervolema: excessive fluid intake, inappropriate fluid retention
What are some of the symptoms of dehydration in adults and children?
- dry skin
- thirst
- tiredness
- headache and dizziness
- crankiness
- sunken eyes
- dark coloured urine
- cold or mottled extremities
- skin turgor
What is ORT?
- inexpensive sugar-salt solution
- reverses secretory diarrhea
- replaces fluid and electrolyte losses
- as effective as IV rehydration for mild-to-moderate dehydration
What are some of the brand name/commercially available ORS therapies?
Pedialyte Advanced care –> contains zinc and prebiotic, decreased severity and duration of diarrhea, can be stored in fridge for 48 hours after opening
Hydralyte –> can be stored in fridge for 30 days after opening
What should patients experiencing diarrhea avoid?
Plain water, fruit juice, sports drinks and carbonated beverages
- do not have solutes in the necessary proportions
- plain water can lead to hyponoatremia
- others may worsen osmotic diarrhea
What are alternatives to commercially available ORS?
- homemade (generally discouraged, mixing errors are frequent)
- apple juice half diluted with water
How do you administer ORS?
15mL/kg/hr or 60mL/kg over 4 hours
If vomiting, give small volumes frequently
Continue until diarrhea resolves
What are the dietary recommendations for patients presenting with diarrhea?
No evidence to support limiting diet
Keep portion sizes small until diarrhea resolves
