OTC - diarrhoea

Question 1

Symptoms?

Answer 1

• frequent loose, watery stools
• associative symtpoms:
  
  • abdominal cramps
  • nausea
  • flatulence
  • dehydration

Question 2

Referral criteria?

Answer 2

DURATION OF ACUTE DIARRHOEA

• babies <3 months immeadiately
• under 1 year, diabetic, elderly >24hrs
• under 3 years >48 hrs
• refer everyone if >3 days

SIGNS OF DEHYDRATION

• dry skin/reduced skin turgor
• sunken eyes
• dry tongue
• drowsiness/lethargy
• less urine/dark urine
• depressed fontanelle in babies

ALARM SYMPTOMS

• blood or mucous in stool (gastric bleeding/bowel cancer/ibd?)
• long standing change in bowel habit
• 50+yrs weight loss
• suspected faceal impaction in elderly (poorly formed stools still difficult to pass)

OTHER SYMPTOMS

• severe vomititng, high grade fever (high risk of dehydration)
• recent travel abroad (giardiasis if travel to non-western country)

CHRONIC DIARRHOEA >3 WEEKS
(IBS, crohns, UC, coeliacs or Diverticular disease)

MEDICATION ADR

• mg antacids (lax)
• NSAIDS (gi effects)
• iron (laxating or const)
• laxatives (overuse)
• antibiotics (antibiotic associated colitis)
• digoxin (toxicity)
• PPIs
• diuretics
• SSRIs (gi effects)

Question 3

OTC products?

Answer 3

FIRST LINE = oral rehydration therapy (all ages), replaces lost fluid and electrolytes

• take 1 or 2 sachets after each loose motion
• dissolve in 200ml (boiled and cooled for babies under a year)

SECOND LINE = loperamide 12+

• antimotility drug binds to opioid receptors in gut to slow peristalsis
• take 2 caps after each loose motion, max 8 a day (adults)
• not recommended in pregnancy or breastfeeding

Question 4

Less recommended OTC alternatives ?

Answer 4

• kaolin and morphine 12+ CDs
• J collis browne mixture
• traditional remedy now less suitable and prone to abuse
• bismuth salicylate 16+ (pepto bismol)
• avoid in aspirin hypersensitvity
• causes black stools and tongue

Question 5

Advice?

Answer 5

• stay hydrated
• eat plain bland foods (avoid dairy - temporary lactose intolerance)
• avoid drinks with high sugar (prolongs diarrhoea)
• babies: dilute formula feeds to 1/4 strength and build back up to normal after 3 days
• feed more frequently than normal and supplement with oral rehydration therapy to prevent dehydration
• travelling abroad - drink bottled water, avoid uncooked fish, meat and poultry, wash hands regularly and use clean towels)