Diarrhea and dehydration

Question 1

What is the definition of diarrhea– acute and chronic?

Answer 1

3 or more loose or watery stools in 24 hours, type 5, 6 or 7
Acute: <14 days
Chronic: >28 days

Question 2

When do you refer for diarrhea?

Answer 2

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

Question 3

What are causes of chronic diarrhea (6)?

Answer 3

Chronic infection or medication use
Neoplasias
Malabsorption
Endocrinopathies
Motility disorders
Chronic inflammation

Question 4

What is osmotic/solute induced pathophysiology of acute diarrhea?

Answer 4

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

Question 5

What is peristaltic pathophysiology of acute diarrhea?

Answer 5

Stimulation of the enteric nervous system increases peristalsis and decreases the time for water absorption
Ex. stress, caffeine, abrupt cessation of opioids

Question 6

What is secretory/electrolyte-related pathophysiology of acute diarrhea?

Answer 6

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

Question 7

What are the 3 types of acute diarrhea?

Answer 7

Secretory/electrolyte related
Peristaltic
Osmotic/solute induced

Question 8

What are dietary triggers of acute diarrhea?

Answer 8

Alcohol
Caffeine
Fructose
Lactose
Sorbitol

Question 9

What kinds of viral infections can cause acute diarrhea?

Answer 9

Norovirus, rotavirus

Question 10

What kinds of bacterial infections can cause diarrhea?

Answer 10

C. perfringens, S. aureus, B. cereus

Salmonella, shigella, campylobacter, E. coli

Question 11

What kinds of parasites can cause acute diarrhea?

Answer 11

Giardia lamblia

Cryptosporidium parvum

Question 12

How can we describe diarrhea in resource-rich settings?

Answer 12

Infectious and self-limiting

Question 13

What is the most common complication of acute dehydration?

Answer 13

dehydration

Question 14

What populations are more prone to dehydration?

Answer 14

Pregnancy
Frail elderly
Child <2 
Vomiting >4h
Immunocompromised
Diabetes, heart failure, kidney failure
Severe diarrhea (>6/day for >48h)

Question 15

Define hypovolemia and hypervolemia

Answer 15

Hypovolemia: poor fluid intake, excessive fluid loss, third spacing
Hypervolemia: excessive fluid intake, inappropriate fluid retention

Question 16

How urgent is dehydration?

Answer 16

Urgent

Question 17

What are ways we can assess for dehydration?

Answer 17

Capillary refill time
Skin turgor assessment
Fontanel (infants)

Question 18

How can we manage acute diarrhea?

Answer 18

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

Question 19

How do we administer ORS?

Answer 19

15mL/kg/hr or 60mL/kg over 4 hours

If vomiting, give small volume frequently and continue until diarrhea stops

Question 20

What are dietary recommendations during acute diarrhea?

Answer 20

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

Question 21

When should we use pharmacological options to treat diarrhea?

Answer 21

When needed for QoL or if ORS has not improved symptoms within 48 hours

Question 22

What pharmacological options are available to treat diarrhea and the kind of severity they’re approriate for?

Answer 22

Psyllium: mild diarrhea
Bismuth subsalicylate: mild-moderate diarrhea
loperamide: moderate-severe diarrhea

Question 23

What is the dosing for the pharmacological options for diarrhea?

Answer 23

Psyllium: BID to QID

bismuth: q30-60 mins PRN
loperamide: initial dose followed by dose after each BM with daily max