Diarrhea Assessment and Non-pharm Flashcards
Definition of diarrhea
Frequent passage of loose, watery stool (>3 per day)
Normal stools – 100 – 300 gm/daily
◦ >300 gm – diarrhea
Classification of diarrhea
acute, persistent, chronic
Acute - <14 days duration
Persistent - >14 days
Chronic - >30 days duration or repeated episodes
Complications of diarrhea
Crohn’s disease, ucerative colitis can lead to blood and mucus in stool
Fluid and electrolyte disturbances (Loss of dosium, potassium, chloride, magnesium)
Dehydration
◦ Infants, young children, elderly
◦ Patients with chronic diseases such as renal failure
and cardiovascular disease
May also see: fever, abdominal pain, flatulence,
weight loss/anorexia if severe.
Depending on cause: blood, mucus (IBS), pus may be
present in stools.
Hemorrhoids
Diarrhea is third leading cause of death in children
getting better
what are 4 causes of diarrhea
Osmotic (brings water into lumen): poorly absorbed substainces
Secretory: deraned fluid and electrolyte transport across mucosa
Exudative/inflammatory: inflammation
Increased gut motility: irritable bowel syndrome, hyperthyroidism, drugs
Common causes of acute diarrhea
Infectious – one of the most common reasons for
acute diarrhea
◦ Bacterial – ie E. coli, Salmonella, Shigella, C. difficile etc
◦ Viral – ie rotavirus, norovirus, etc
◦ Food toxins
◦ In developing countries could lead to chronic
diarrhea
Drugs – see Table 2 in lecture handout
◦ Also consider herbals
which drugs are associated with diarrhea
laxatives antacids (magnesium) antibioitcs theophylline cholinergic drugs promotility agents prostaglandins (misoprostil) SSRIs sulfasalazine antihypertensives (propanolol, ACEI) NSAIDs some chemotherapeutic agents
Clostridium difficile infections (CDI)
Anaerobic bacteria – Clostridium difficile
Associated with antibiotics:
◦ most common with clindamycin, ampicillin and
cephalosporins
Range of symptoms includes severe symptoms with
watery diarrhea, abdominal pain/distension, fever
etc to no symptoms (carrier state)
Patient Assessment: Diarrhea
1) Identify the predominant symptoms
Stool frequency Stool characteristics – soft or liquid Onset and duration of diarrhea Presence of blood, mucous, pus in stools Distinguish acute vs chronic
Patient Assessment: Diarrhea
2. Assess for other symptoms
Fever, N/V Abdominal pain Signs of dehydration Altered mental status (ie lethargy etc) Beware of fecal incontinence and fecal impaction (ie severe constipation)
Patient Assessment: Diarrhea
3. Identify potential causes
Timing of symptoms with recent ingestion of
unusual foods
Recent travel history (rule out Traveler’s Diarrhea)
Identifiable drug causes
◦ use of antibiotics
◦ check for other drugs, OTC and natural health
products
Past use of laxatives
Medical conditions
Traveller’s Diarrhea
causes
Travel to developing countries with poor standards for
hygiene/sanitation
Onset usually 1 – 2 days of ingesting contaminated food
– and up to 7 – 10 days after returning home.
May be accompanied by abdominal cramping, fever or
vomiting.
Causes: bacteria (enterotoxigenic Escherichia coli,
Campylobacter, Shigella or Salmonella), parasites (ie
Giardia) and viruses (Norovirus, Rotavirus)
Most cases are self-limiting (< 7 days)
Traveller’s Diarrhea
Patients at risk for traveller’s diarrhea:
Immunocompromised Frail elderly Children Inflammatory bowel disease Chronic diseases (cardiac, renal) Reduced stomach acidity Diabetes
Patient Assessment: Diarrhea
4. Assess for “red flags” that should be referred.
Features of Diarrhea: Fever (>38.5℃) Bloody stools Severe abdominal pain/cramping Severe diarrhea (>6 loose stools in 24 hour period) Diarrhea > 7 days Signs of severe dehydration Clostridium difficile infections
Features of the Patient: Young children (<2y) Frail elderly Pregnancy Presence of multiple chronic conditions (ie cardiovascular, CKD, DM) Immunocompromised (HIV, cancer)
Patient Assessment: Diarrhea
5. Assess what has been tried to help with diarrhea
◦ For how long?
◦ What doses?
◦ How did it work?
◦ Were there any side effects?
Therapeutic Approach: Non-pharmacologic
Discontinue medications that could be causing
diarrhea
Adequate rehydration
◦ Maintain electrolyte balance
◦ Clear fluids for 24 hours
◦ Oral rehydration therapy
◦ Avoid fruit juice and carbonated drinks
