Diarrhea

Question 1

Causes of diarrhea

Answer 1

Drug-induced
Foods
Stomach flu
Travel

Question 2

Common treatments of diarrhea

Answer 2

Hydration
Imodium
Pepto

Question 3

Sudden causes of diarrhea

Answer 3

Food poisoning
Travellers diarrhea
Stomach flu

Question 4

Chronic diarrhea causes

Answer 4

Celiac disease
Food intolerance/allergy
Milk/soy protein intolerance
IBS
Medications

Question 5

Drug induced diarrhea

Answer 5

20% of people taking antibiotics
Diarrhea usually starts 2-3 days into treatment

Question 6

Treatment of drug-induced diarrhea

Answer 6

Withdraw the drug OR
Continue treatment but Add loperamide to counteract AE
OR adjust dose (very unlikely)

Question 7

What is the main cause of paediatric diarrhea?

Answer 7

Viral gastroenteritis (VGE) - aka stomach flu

Question 8

What is mild dehydration in peds?

Answer 8

Up to 5% body weight loss
Increased thirst
Slightly dry mucous membrane

Question 9

What is moderate dehydration in peds?

Answer 9

6-9% body weight loss
Irritable, alert, thirsty
Dry mucous membrane

Question 10

What is severe dehydration in peds?

Answer 10

> 10% body weight loss
No urine output
Parched mucous membrane
Cold extremities

Question 11

When should you refer for peds?

Answer 11

Anything past mild dehydration
<6 months
<1yr = 1 day duration
2yr = 2 day duration
3yr = 3 day duration
If fever, vomiting >8hr, blood in stool is present

Question 12

What are the treatment for VGE at home?

Answer 12

Rehydration therapy (key treatment)
Anti-diarrheal agents for kids (not really any that are recommended)

Question 13

What is the presentation of travellers diarrhea?

Answer 13

E. Coli is the common cause
Diarrhea within 3-7 days upon arrival
Average of 4-5 BMs per day
Low grade fever
Usually self-limiting over several days

Question 14

What is montezuma’s revenge?

Answer 14

3% have >10 BM/day
15% also have vomit
10% last >week

Question 15

Prevention for travellers diarrhea

Answer 15

Giving rx antibiotic before leaving - start at destination for max of 3 weeks
Pepto-bismol - 2T 262mg QID for 3 weeks max (great for adults)

Question 16

Treatment options for travellers diarrhe

Answer 16

Main: 1-3 days of rx antibiotic + loperamide
OR loperamide alone
OR pepto alone

Question 17

What is the side effect of an rx antibiotic + loperamide?

Answer 17

Bloody stools

Question 18

Treatment of travellers diarrhea for children

Answer 18

First choice: fluid
Loperamide only if kid is suffering
Pepto 2 x 262mg q30 minutes for 8 doses

Question 19

What are the side effect of pepto?

Answer 19

Harmless darkening of tongue or stools
Ulcer, bleeding

Question 20

Cause of diarrhea from hep A

Answer 20

Contaminated water, ice, shellfish, raw fruits or vegetables

Question 21

Symptoms of diarrhea with hep A

Answer 21

Mild illness lasting 1-2 weeks to a severely disabling disease lasting months

Question 22

Common causes of diarrhea from hep B

Answer 22

Unprotected sex, sharing needles, tattooing. Body fluids and blood
Can take 2-6 months for symptoms to appear

Question 23

Symptoms of hep B

Answer 23

N+V
Fever
Dark urine
Can develop into jaundice

Question 24

What is the dosing for Imodium(loperamide)?

Answer 24

2 caps immediately, then 1 after each loose BM (16mg max per day)
Not recommended for 2-12 yo
CI <2yo

Question 25

Probiotics use in diarrhea cases

Answer 25

For antibiotic induced diarrhea

Question 26

Indications of pepto

Answer 26

Indigestion
Upset stomach
N+D
Heartburn
But there is usually better options for each indication
Can give to children > 3yo