Diarrhea Flashcards
Things to consider when pt has diarrhea?
- Duration: acute v. chronic
- Consistency
- +/- blood
- location and/or travel
- comorbidities: IBD, IBS, GI surgery, HIV/AIDS
- Sick contacts
- Recent hospitalization
- Food
- Recent antibiotic exposure
for the most part, management of diarrhea is supportive and ____ is key.
hydration
how would you know the cause of diarrhea is likely bacteria?
diarrhea is severe (>4 liquid stools/d x 3 d)
______ is most critical therapy in diarrheal illnesses
Rehydration
according to WHO, what is the preferred route of rehydration?
oral
rehydration solutions consist of? (4)
o Sodium chloride
o Sodium bicarbonate
o Potassium chloride
o Glucose or sucrose
products available for rehydration solutions (3)
o WHO-ORS
o Rehydralyte
o Cera-lyte
can gatorade be used as rehydration therapy?
no.
Watered fruit juice, Gatorade, soda are not the same and should not be considered in severe dehydration
although there is no clinical trials to support specific diets for diarrheal illnesses, what 4 are commonly used?
- BRAT diet: Bananas, rice, applesauce, and toast.
- Boiled starches and cereals with salt
- Crackers
- Boiled vegetables with salt
should you use dairy in a diet with someone that has severe diarrhea?
no.
you should avoid Lactose-containing foods and High-fat foods
Antibiotics are usually not needed for diarrhea treatment unless there is a strong indication. what are these indications? (7)
- Mod-severe travelers’ diarrhea with >4 unformed stools daily, fever, blood, pus, or mucus in stool
- > 8 stools/d
- Severe volume depletion
- Symptoms >1 week
- If hospitalization is considered
- Immunocompromised
- Evidence from stool studies
if you suspect the diarrhea is caused by a bacteria, what antibiotic should you use to treat it?
ciprofloxacin or levofloxacin x 3-5 d
Alt: azithromycin or TMP-SMX x 3-5 d (Bactrim)
When might you want to use azithromycin or TMP-SMX to treat diarrhea instead of cipro or levo?
If they are under 20, pregnant, etc may not want to use FQ
What are 2 exceptions of diarrheal illnesses that you won’t use this standard antibiotic treatment?
o Enterohemorrhagic E. coli (EHEC)
o Clostridium difficile
should you treat the diarrhea with an antibiotic if a pt comes in with extreme diarrhea and bleeding?
no, it can be Enterohemorrhagic E. coli (EHEC)
- giving them abx could kill them
What should you do if you are treating a pt with cipro for diarrhea and find out they have c. diff?
Stop antibiotics and use metronidazole or PO vancomycin
symptomatic treatment for diarrhea include what 5 medications?
- Loperamide (Imodium)
- Diphenoxylate + atropine (Lomotil)
- Bismuth subsalicylate (Pepto-Bismol)
- Anticholinergics
- Intraluminal adsorbents
what are two antimotility agents that can be used to help treat symptoms in a pt with diarrhea?
o Loperamide (Imodium) o Diphenoxylate + atropine (Lomotil)
why is atropine added to diphenoxylate?
Diphenoxylate is structurally related to opioids, so atropine helps prevent people from abusing it
Loperamide and Diphenoxylate + atropine are Both are analogs of_____.
meperidine
can you use Loperamide or Diphenoxylate + atropine when a pt with diarrhea presents with fever or bloody stool?
NO
Should NOT be used with fever, bloody stool
what are the ADRs of Loperamide and Diphenoxylate + atropine?
drowsiness, cramps
how can Loperamide (Imodium) be misused?
o Treat symptoms of opioid withdrawal
o Euphoria
in JUNE 2016, FDA put out what warning for Loperamide (Imodium)
serious/fatal cardiac arrhythmias
Mainly with use over recommended daily dose
8 mg OTC; 16 mg Rx
