Diarrhea and dehydration Flashcards
What is the definition of diarrhea– acute and chronic?
3 or more loose or watery stools in 24 hours, type 5, 6 or 7
Acute: <14 days
Chronic: >28 days
When do you refer for diarrhea?
All diarrhea >14 days Fever >38.5 Worsening diarrhea Blood/mucous in stool Weight loss due to diarrhea Immunocompromised patients Severe abdominal pain/cramping Recent use of antibiotcs/hospitalization
What are causes of chronic diarrhea (6)?
Chronic infection or medication use Neoplasias Malabsorption Endocrinopathies Motility disorders Chronic inflammation
What is osmotic/solute induced pathophysiology of acute diarrhea?
Too many solutes in the gut lumen decrease the osmotic gradient and decrease water absorption
Unabsorbable or poorly absorbed solutes (ex. lactose intolerance, osmotic laxatives, fructose, sugar substitutes)
Will improve with fasting
What is peristaltic pathophysiology of acute diarrhea?
Stimulation of the enteric nervous system increases peristalsis and decreases the time for water absorption
Ex. stress, caffeine, abrupt cessation of opioids
What is secretory/electrolyte-related pathophysiology of acute diarrhea?
Reversed ion transport across intestinal membrane (actively adding solute into the gut) decreases osmotic gradient and decreases water absorption
Ex. bowel ischemia, misoprostol, viral/bacterial enterotoxins
What are the 3 types of acute diarrhea?
Secretory/electrolyte related
Peristaltic
Osmotic/solute induced
What are dietary triggers of acute diarrhea?
Alcohol Caffeine Fructose Lactose Sorbitol
What kinds of viral infections can cause acute diarrhea?
Norovirus, rotavirus
What kinds of bacterial infections can cause diarrhea?
C. perfringens, S. aureus, B. cereus
Salmonella, shigella, campylobacter, E. coli
What kinds of parasites can cause acute diarrhea?
Giardia lamblia
Cryptosporidium parvum
How can we describe diarrhea in resource-rich settings?
Infectious and self-limiting
What is the most common complication of acute dehydration?
dehydration
What populations are more prone to dehydration?
Pregnancy Frail elderly Child <2 Vomiting >4h Immunocompromised Diabetes, heart failure, kidney failure Severe diarrhea (>6/day for >48h)
Define hypovolemia and hypervolemia
Hypovolemia: poor fluid intake, excessive fluid loss, third spacing
Hypervolemia: excessive fluid intake, inappropriate fluid retention
How urgent is dehydration?
Urgent
What are ways we can assess for dehydration?
Capillary refill time
Skin turgor assessment
Fontanel (infants)
How can we manage acute diarrhea?
Try to identify cause. Because it’s self limiting, we don’t need to do anything about the infection itself
Recommend oral rehydration therapy– will decrease stool output, vomiting, and need for IV rehydration
How do we administer ORS?
15mL/kg/hr or 60mL/kg over 4 hours
If vomiting, give small volume frequently and continue until diarrhea stops
What are dietary recommendations during acute diarrhea?
Do not limit diet- may cause malnutrition
Keep portion sizes small
Breast and bottle-feeding should continue along with ORS
Zinc supplementation x10-14d for those at risk of deficiency
When should we use pharmacological options to treat diarrhea?
When needed for QoL or if ORS has not improved symptoms within 48 hours
What pharmacological options are available to treat diarrhea and the kind of severity they’re approriate for?
Psyllium: mild diarrhea
Bismuth subsalicylate: mild-moderate diarrhea
loperamide: moderate-severe diarrhea
What is the dosing for the pharmacological options for diarrhea?
Psyllium: BID to QID
bismuth: q30-60 mins PRN
loperamide: initial dose followed by dose after each BM with daily max
