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Diarrhea (Causes of Diarrhea: (Viral Gastroenteritis- (contaminated food
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Diarrhea
Causes of Diarrhea:
Viral Gastroenteritis-
- contaminated food
- contaminated water supply
- Rotavirus:
- common w/ children b/t 3-24 months (ex. daycare, fecal to oral )
- Norovirus:
- associated with cruise ships (in close contact)
- note: these are self eliminating
-
Protozoal-
- refer! :no_entry:
- Giardia: children, travelers, institutionalized; contaminated water
- Cryptosporidium: immunosuppressed (ex AIDs pts), travelers, and children in developing countries
Drug-induced-
- antibacterial agents: bc rides of natural flora (protection)
- cytotoxic agents (chemo): wipe all fast growing cells like GI tract cells
- laxatives: moves things
- magnesium products: builds fluid into intestine
AIDS-associated-
- refer!
- may be due to infection
Food-induced-
- food allergy
- excessively fatty or spicy
- high amt of roughage: carrots, apples with skin, seeds
- lactase deficiency : milk/dairy products
-
PREVENTION
- wash hands
- sterile techniques: clean and disinfect
- strict food handling
-
Isolate pt: daycare, nursing home
Traveler's Diarrhea: bismuth subsalicylate (peptobismol) prophylaxis of high risk areas (not FDA approved)
MEDICATIONS
Loperamide
Imodium AD:
- 2 mg / caplet
- 1mg/5mL (liquid works faster)
Imodium Advanced:
- loperamide 2 mg
- simethacone 125 mg (antigas)
DRUG INFO
Indication:
- acute, NONspecific diarrhea
- Traveler's diarrhea
- chronic diarrhea associated w/ IBS
MOA:
- slows intestinal mobility
Effects:
- reduce daily fecal volume
- INC viscosity (slow motility)
- INC bulk volume (slow motility)
- DEC fluid & electrolyte loss
DOSAGE:
- 4 mg initially, then 2 mg after each loose stool (ADULTS)
- max 16 mg/d (ADULTS)
- children: max depends on weight
- Duration of use 48 hours :no_entry: bc something else is going on
Adverse Effects:
- DEC CNS poorly
- dizziness
- constipation
Contraindication / Warnings:
- NOT < 6 y/o :no_entry:
- febrile (something else)
- blood or mucus in the stool
- Geriatrics: may cause CNS depression, more sensitive
Bismuth Subsalicyate
DRUG INFO
EFFECTS:
- reduce the frequency of unformed stools
- INC stool consistency
- relieves sx of abdominal cramping
- DEC N/V
- antimicrobials effect
INDICATIONS:
- mild, nonspecific diarrhea (even Traveler's)
- indigestion, sour stomach
- h.pylori (causes ulcers)
ADVERSE:
- In combination with other Salicylate
- Tinnitus
- Reye’s syndrome
- Black staining of stool
- Darkening of the tongue
CONTRAINDIATIONS:
- Antiplatelet effect
- Pregnancy
- Lactation
- AIDS due to neurotoxicity (encephalopathy)
GERIATRICS
- May cause tinnitus or CNS side effects (signs of salicylate toxicity)
- Potential for interactions with anticoagulants (coumadin)
DRUG INTERACTION
- With warfarin, valproic acid, methotrexate:
- With probenecid: ↓ effects
- With tetracycline, fluoroquinolone:
- DECREASE absorption of antibiotics
PROPHYLAXIS FOR TRAVELER'S DIARRHEA
- Not FDA approved
- 2 tabs qid or 1 fluid ounces qid
- Do not use for greater than 3 weeks
DOSAGE:
- 2 tabs/caplet every hour
- 30 mL per 30-60 mins
- max 240 mL per day
- Labeled for children young as 12
DURATION OF USE:
- 48 hours (after this, may be something else) :warning:
BISMUTH SUBSALICYLATE POTASSIUM:
- Pylera:
- H. Pylori
- Dose:
- 1 cap bismuth subcitrate potassium 140 mg
- 1 cap metronidazole 125 mg
- 1 cap tetracycline 125 mg-(small capsule-size 3)
- drug is encapsulated causing a barrier to avoid contact with bismuth subcitrate potassium
- 3 capsules qid, pc and hs X 10 days
- USE: Treatment of Duodenal Ulcers
-
-
-
Treatment:
Treatment Goals: :
- prevent or correct fluid and electrolyte loss & acid-base disturbance
- relieve sx
- ID and treat the cause
- prevent acute morbidity and mortality
General Treatment Approach:
- fluid electrolyte balance
- diet
- nonprescription meds
-
DIET
- oral intake does not worsen
-age appropriate: infant & children
- --> formula and breast milk is okay
- foods to eat: ** carb rich, yogurt, lean meats, fruits, vegetables
- banana, rice, apples, toast, tea, yogurt (BRATTY)
- avoid: fatty foods, simple sugars, spicy, caffeine