W10. Diarrhea and Dehydration Flashcards
what is diarrhea
3 or more loose or waery stools in 24 hours
*type 5, 6 or 7
can be acute <14day
chronic >28 days
etiology of chronic diarrhea
- chronic infection or mediaction use
- Neoplasias (colon cancer, lymphoma)
- malabsorption syndromes (celiac disease)
- endocrinopathies (hypoertyroidism, addisons disease)
- motility disorders (diabetic autonomic neuropathy, IBC)
- chronic inflammation (diverticulitis, IBS, Crohn’s, ulcerative Colitis, ischemic colitis, radiation colitis)
*REFER all chronic diarrhea
athophysiology of acute diarrhea: osmotic or solute induced
*caused bc too many osmotically active solubtes in gut lumen, cant be adequately brough in, not absorabable/poorly abs. water stays where soltues are
- osmotically active solutes present in gut lumen -> dec osmotic gradient -> dec water abs
- unabsorable or poorly abs solutes
- > lactose intolerance/lactase deficiency
- > osmotic laxatives (polyethylene glycol/PEG, magnesium salts, sodium phsopshate, lactulose)
- > large intake of fructure (fruit juices, soft drinks) or sugar substitues (sorbitol, mannitol, xylitol)
*little kids drinking lots of soft drinks or fruit jucies can get diarrhea form this
how can you differentiate osmotic or solute induced acute diarrhea from others
when patient stops eating diarrhea stops
if solutes are not in the gut lumen then they dont keep water iwth it and dont have diarrhea
peristaltic & diarrhea
*due to inc peristalsis, thigns mvoign trhough faster so not enough contact time to reabs the water
- stimulation fo enteri NS -> INC peristalsis -> DEC time for water abs
ex: triggered by stress, caffeine, abrupt cessation of opioids(opiods slow peristalsis so will have storng rebound effect)
pathophysioloy of acute diarrhea: Secretory or Electrolyte‐Related
*simialr to first one, but this one the ion transporter isnt working properly
*ions stay in gut lumen or its reversed and pumps pump ions into gut lumen
- Ion transport across intestinal membrane is reversed (ions are secreted into gut lumen)
- causes decrease in osmotic gradient -> decreases water abs (may even pull from intravascular space)
- often combines with inc in peristalsis
*this is pulling water out your BV so they beocme SUPER dehydrated
ex of tings triggering Secretory or Electrolyte‐Related diarrhea
- Bowel ischemia (causes pump to not work properly)
- Misoprostol (i.e., prostaglandin analogue, makes ion pump malfunction)
- Viral enterotoxins (e.g., rotavirus, norovirus)
- Bacterial enterotoxins (e.g., cholera, C. difficile, E. coli )
*also sitmulates enteric NS
*main way that viruses cause this
Etiology of Acute Diarrhea:: dietary triggers
- Alcohol (e.g., wine, beer)
- Caffeine (e.g., coffee, tea, cola)
- Fructose (e.g., juice, soft drinks)
- Lactose (e.g., milk, ice cream, yogurt)
- Sorbitol (e.g., sugar‐free gum, prunes)
Etiology of Acute Diarrhea: Medication Triggers
• SSRIs
• NSAIDs
• Laxatives
• Colchicine
- Magnesium‐containing antacids (not well abs solute)
- Antibiotics (kill off gut flora, cause special type of diarrhea)
- Lithium • Digoxin Allopurinol • Levothyroxine • ACE inhibitors • Anticoagulants • Prostaglandins • Mycophenolate • Antidiabetic agents • Proton pump inhibitors • H 2‐receptor antagonists • Chemotherapeutic agents • Acetylcholinesterase inhibitors • Sorbitol‐containing elixirs (e.g., potassium)
types of poop
1: rabiit droppings
2: lumpy bunhc of grapes more water drawm out
3-4 two iteal ones: more smooth consistent piece
5: soft blobs with clear but edges, passed easily
6: more broken some like porridge
7. lqiuid no solid
Etiology of Acute Diarrhea: Infections (aka Gastroenteritis)
- Viruses (most common)
- facal oral transmission
- year round, most common in Nov-Apil
- stomach flu (N/V, abdo pain, HA, malaise, fever/chills) *not acutally flu just lfu like symptoms
- Norovirus, Rotavirus (most sig cause of severe diarrhea, vaccine now available)
- Bacteria
- contaminated food/water (except C.diff)
- Aka food poisoning (travelers diarrhea)
- in canada: C.perfringes, S. aureus, B. cereus (N/V/bloat)
- Salmonella, shigella, campylobacter, e.coli (fever, severe abdopain, blood in stool) *more dangerous
- Parasites
- contimainted food/water (lakes/pools), fecal-oral
- both can lead to chronic symp
- less common
- in canada mainly Giardia lamblia (fatty looking stool steatorrhea, bloating cramps, weight loss)
how can you prevent infectious diarrhea
- drinka nd use clean, safe water
- follow hand hygiene guidelines, esp if sick
- practice food safety: watch best before dates, wash fruits and veg before cutting, cook thoroughly w/ food thermometer, sep utensils &cutting boards for raw meat
- thaw in fridge, old water or microwave and cook immediately
- keep raw meat separate from other foods in grocecry cart/fridge
most acute diarrhea is
infectious and self limiting
when to refer acute diarrhea
- Fever ≥ 38.5 °C
- Diarrhea > 14 days
- Worsening diarrhea
- Blood or mucus in stool
- Weight loss due to diarrhea
- Immunocompromised patients
- Severe abdominal pain or cramping
- Recent use of antibiotics/ recent hospitalization
signs fo dehydration
- dec skin turgor
- dec BP, INC HR, INC RR
- INC urea: SCr/ INC Na
= INC capillary refill time (> 2 sec)
- >20 mmHg SBP dec from sit to stand
dehydration symtpoms in infants
Fever
• No tears •
Dry mouth
- Sunken eyes
- Sunken fontanel
- Unusual tiredness
- No wet diapers in ≥ 3 hrs
- Cold or mottled extremities
When to sue Pharm options for acute diarrhea
*usually just use ORS
can be used in addition to ORT when needed for QoL or symptoms not improved within 48 Hours
