Diarrhea Flashcards
complications of diarrhea
electrolyte imbalance
dehydration
hemorrhoids
acute vs chronic
acute < 14 days
chronic: >14 days or recurring
causes of acute
infections
medications
diet/nutrition
how long does diarrhea last
2-3 days
most common cause of viral gastroenteritis
noroviruses
24 hour stomach flu
rotaviruses causes what? which age is highest incidence
acute gastroenteritis and infantile diarrhea
highest incidence between 3-24 months
causes of salmonella and how long it lasts
infected poultry, eggs, beef, veges, milk, fruit
1-7 days
campylobacter causes and duration
uncooked chicken, unpasteurized milk, contaminated water 1-10 days
ecoli causes and duration
contamined food/water, travel
3-5 days, 5-10 days
shiga toxin from ecoli causes what serious syndrome
hemolytic uremic
common parasites that cause diarrhea and treatment
g.lamblia
e.histolytica
i.belli
cryptosproridium sp.
referral cant self treat
how is giardia spread
ingestion of food/water contaminated with animal or human feces containing cysts
when does diarrhea caused by broad spectrum antibiotics start and resolve
2-3 days after starting antibiotic
resolved when stop antibiotic
complication of antibiotic induced diarrhea
pseudomembranous colitis
medications that cause diarrhea
laxatives Mg antacids metoclopramide orlistat acarbose misoprostol antineoplastics opiate withdrawal
diet that causes acute diarrhea
gluten and lactose
sorbitol or mannitol
fatty, spicy, salted
rapid increase in dietary fibre
causes of chronic diarrhea
IBD, chrons, UC, IBS tumors chemo malabsorption of carbs diabetes diet, meds, infection
risk factors for infectious diarrhea
day care centers food handler or care giver crowded living conditions consumption of unsafe food certain medical conditions
2 important questions to always ask
do you hvae a fever - sign of infection
blood in stool
red flags
fever over 38.5 excesive ab pain, cramping blood or mucous in stool dehydration, weight loss vomit >4hrs under 2 yrs old or frail severe: >6stools/day for >48 hours chronic medical condition laxative abuse pregnant immunocompromised recent antibiotic use worsening or persistent
signs and symptoms of dehydration
dry mouth, tongue increased thirst decreased urination weak lightheaded children: few tears, sunken eyes, grey skin
treatment goals
determine cause relieve symptoms re-establish normal stools prevent/correcct fluid and electrolyte loss or imbalance prevent complications
non pharms
handwashing before and after meals, going to bathroom
prevent food poisoning
oral rehydration
early refeeding and maintenance of hydration
follow age appropriate diet
avoid fatty food and simple sugars and spicy foos
avoid caffiene - may promote fluid secretion
how to prevent food poisoning
avoid unpasteurized milk and juice cook meat, eggs throughly keep hot foods hot and cold col rinse uncooked foods first separate cutting boards for raw meat reheat food completely
contraindications to oral rehydration therapy
protracted vomiting, worsening, unable to keep up wiht losses, stupor, coma, intestinal ileus
are sports drinks recommended
no due to high sugar and low amounts of electrolytes
what is contained in oral rehydration therapy and their purpose
glucose and electrolytes
glucose provides calories and aids in absorption of sodium and water
osmolality- 1glucose:1sodium
what is in gastrolyte
oral rehydration salts - citrate
directions and dose of gastrolyte
stir in 200ml water and drink freely and frequently while diarrhea continues
pedialytle contains what
correct balance of electrolytes, sugar, and water
loperamide MOA
synthetic opioid agonist
slows intestinal motility allowing absorption of electrolytes and water
decrease Gi secretion
reduce of daily fecal volume, increase viscosity and bulk volume, reduce fluid and electrolyte loss
indication of loperamide
acute diarrhea, travelers (only treatment)
chronic diarrhea associated with IBS
adjunct to rehydration therapy
age restriciton and use in pregnancy of loperamide
not under 12 or in pregnancy without doctor recommendation
CI in under 2
side effects of loperamide
abdominal pain distention cramps NV dry mouth constipation drowsy fatigue skin rash worsens effects of invasive bacteria
dose of loperamide***
4mg initially
followed by 2mg after each loose stool
max use for loperamide
16mg/day
2 days
CI of loperamide
blood/mucus in stool fever infectious diarrhea acute ulcerative colotis pseudomembranous colitis under 2
onset of loperamide
.5-1 hour
severe drug interaction with loperamide
saquinavir
why is there abuse with loperamide
high doses can cross BB and reach central opioid receptors leading to euphoria
effects of loperamide at high doses
CNS toxicity and cardiac toxicity
dizziness, urinary retention, syncope, SOB, palpitations, dytonia
bismuth MOA in pepto
antimicrobial effect against diarrhea causing pathogens
salicylates MOA in pepto
antisecretory effects that rescues fluid and electrolyte losses
bismuth subsalicylate MOA
decrease frequency of unformed stools
increase stool consistency
relieve ab cramping
decreased NV
indication of bismuth subsalicylate
symptom releif of diarrhea
travellers (px or Tx)
adjuvant to antibiotic treatment of h pylori
age restrictions for pepto
children =/>3
not for children under 18 with febrile viral illness due to risk of reyes
adverse effects of pepto
impaction- infants and dehibilitated pts
grey/black stools and tongues
tinnitus
headache, confusion
cautions with pepto
children recovering from chicken pox/flu
sensitive to aspirin
taking anticoagulants or other salicylates
AIDS (neurotoxicity)
Gi bleeds
onset of action for pepto
none so prob doesnt work
drug interactions with pepto
take 3 hours apart from other meds
anticoagulants, salicylates,- has antiplatelet effects
probenedic and methotrexate
MOA of attapulgite
absorbs 8x its weight in water - absorption not selective ex.toxins, drugs
reduces number of BM, relieves cramps, improve stool consistency
age resriction of attapulgite
over 3-6
side effects of attapulgite
mild constipation
dyspepsia
flatulence
nausea
onset of attapulgite
12-19.5 hours
drug interactions with attapulgite
no known drug interactions
wait 2-3 hours of other drugs
fibre MOA
adjusts the consistency of stool by absorbing water in the intestinal tract
side effects of fibre
cramping
flatulence
onset for fibre
12-24 hours
peak in 2-3 days
monitoring for acute diarrhea
signs and symptoms of dehydration such as dry mouth, thirst
doesnt resolve in 48 hours, worsens, high fever, blood/mucus in stool - refer
should see improvement in 1-2 days
definition of travellers diarrhea
3 or more loose unformed stools per day along with one symptom of enteric infection (fever, ab cramps, nausea, fecal urgency or dysentery)
mild categorization of travellers diarrhea
mild: 1/2 unformed stools in 24 hours with no other symptoms
moderate categorization of diarrhea
1/2 unfromed stools in 24 hours with one of the other symptoms or more than 2 unformed in 24 hours with no other symptoms
classic categorization of travellers diarrhea
3 or more unformed stools in 24 hours with at least one other symptoms
types of traveller bacteria
ecoli
clostridium
shigella
salmonella
is travellers diarrhea contagious
hows it spread
no
fecal-oral
risk factors for developing TD or complications
region has poor hygiene/sanitation remote area with no medical amenities reduced stomach acidity children or young adults are more advernturous elderly or frail immunocomprmised IBD severe cardiac or renal disease
who is at high risk of TD and should be referred for prescription prophylaxis
high risk areas where its critical not to fall ill
underlying health problems that make them more susceptible to TD or complication
taking PPIs, h2blockers, or antacids
repeated history of severe TD
if dehydration could cause sever complications
underlying disease -immunocompromised
non pharms for TD
boil it cook it peel it or forget it purified or hot water to brush teeth drink water from sealed bottle avoid consuming water while swimming wash hands before and after eating eat fully cooked food thats hot when served ice from purified water carbonated drinks safe avoid food from street vendors avoid unpasteurized dairy products
