diarrhoea

Question 1

what are the symptoms of diarrhoea?

Answer 1

● Abdominal cramps
● Weakness
● Flatulence
● Vomiting
● Headache

Question 2

what are the red flag symptoms of diarrhoea?

Answer 2

• Babies younger than 3 months
• Children under 1 year
• Children under 3 years
• Adults and children over 3 years Diabetes
• Drowsiness, confusion, passing little urine, sunken eyes, dry mouth/tongue, weakness, cold hands/feet, persistent vomiting, blood in vomit
• Blood or mucus in stools
• Alternating constipation and diarrhoea, especially in the elderly
• Long Term changes in bowel habit in patients over the age of 50 years
• Regular purchase of morphine/codeine-based

Question 3

what is lifestyle advice / non drug treatment?

Answer 3

• Drink plenty of fluids to replace those lost due to diarrhoea to prevent dehydration
• Avoid milky drinks as diarrhoea causes a temporary loss of intestinal cells, causing
  lactose intolerance
• Avoid drinks high in sugar as they may prolong diarrhoea
• Try to eat food
• General hygiene measures that can prevent contracting or spreading infective diarrhoea

Question 4

what is first line drug treatment for diarrhoea?

Answer 4

Oral rehydration therapy

- used to prevent dehydration and replace the fluid lost

Question 5

examples of ORT?

Answer 5

Diaralyte and Electrolade

Question 6

what is second line for diarrhoea?

Answer 6

Antimotility -> Loperamide

Question 7

how does lopermaide work?

Answer 7

Reduces duration of symptoms by binding to opiate receptors in the gut wall
● Take two 2mg capsules after each loose stool, up to a maximum of 8 capsules a day
● If no improvement is seen after 48 hours, the patient should be referred to the GP

Question 8

what are other drugs that can be used for diarrhoea?

Answer 8

• morphine based
• kaolin
• bismuth salicylate

Question 9

how do morphine based prepareations work?

Answer 9

○ Reduction of gut motility is a common side effect of opiate preparations
○ Has been used as a remedy for multiple years – not used as commonly today

Question 10

how does kaolin work?

Answer 10

○ Traditional medical preparation

○ Theory is that absorbs bacteria and toxins and then removes them from the gut

Question 11

how does bismuth salicylate work/

Answer 11

○ Alternative remedy
○ Thought to work in a similar manner to Kaolin
○ Should be avoided in people who are sensitive to aspirin due to the risk of it causing
salicylate absorption

Question 12

who is oral rehydration therapy not suitable for?

Answer 12

○ Diabetics
○ Liver disease
○ Kidney disease
○ Patients on low salt (sodium or potassium) diets

Question 13

who is loperamide not suitable for?

Answer 13

○ Children under the age of 12 years
○ Inflammatory bowel disease
○ Post bowel surgery
○ Post pelvic radiation
○ Colorectal cancer
○ Pregnancy
○ Breastfeeding
○ Blood in stools
○ Lactose intolerance
○ Bacterial enterocolitis caused by salmonella, shigella or campylobacter