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1

Epidemiology of Diarrhea

Prevalence HIGHEST in children <5 yo

 

lowest in adults >65 yo

2

Etiology of Diarrhea

Poor Sanitation + Hygiene

parasites / bacteria / virus

Day care / food handler / caregiver / close living

Consumption of unsafe foods

Medications / Medical COnditions

3

EX-ST for Diarrhea

< 6 months old

SEVERE DEHYDRATION HIGH FEVER >102.2F

PREGNANCY

blood / mucus / pus / protracted VOMIT

Severe ab pain / risk for complications w/ disease

chronic / persistant diarrhea

Inability to take ORT (or poor response to ORT)

4

Fluid / ELectrolyte Management

for Diarrhea

ORAL REHYDRATION THERAPY (ORT)

glucose / sodium / chloride / citrate / potassium

Recommended in Mild-Moderate Diarrhea

as effective as IV replacement in children

Lower Osmolarity vs 

electrolyte dextrose drinks (gatorade

5

Mild to Moderate

Dehydration / Diarrhea

3 - 9 % loss of body weight

Fatigued / restless / irritable

normal to increased HEART RATE

normal to decreased pulse quality

decreased tears / urine output

cool extremeties / thirsty

<5 unformed stools per day

6

ORT for childrean

1 month to 5 years old

50-100 ml/kg

over 3-4 hours

10ml/kg per each loose stool

Maintanance:

Continue ORT for 4-6 hours until rehydrated

resume normal eating

Ideally 3:1 ratio of glucose to sodium

7

ORT for children or adults

>5 years old

2-4L

over 3-4 hours

Replace losses

Maintanence:

Continue ORT PRN

normal diet

Symptomatic Drug Therapy

Gatorade is 15:1 ratio (lot of water)

8

Pharmacologic Treatment of 

Diarrhea

Loperimide

Imodium A-D

Bismuth Subsalicylate

Pepto Bismol

9

Loperamide

Indication / MoA

Imodium AD

Opioid agonist

slows motility --> allows for absorption

Used for: Traveler's Diarrhea / Acute diarrhea / IBD

afibrile or low grade fecer

10

Loperamide

ADR / DI / Counseling

Imodium

DNU <6 yo

Ab pain / dizziness / constipation

avoid in pt if signs of INVASIVE INFECTION

 

11

Bismuth Subsalicylate

MoA / Indications

Pepto Bismol

Reacts w/ HCL --> bismuth oxycholride + salicylic acid

ANTIMICROBIAL EFFECTS OF BISMUTH

Reduces freq of unformed stools

Relives ab cramp 

decrease nausea + vomiting

Used for Acute Diarrhea / Traveler's Diarrhea

12

Bismuth Subsalicylate

ADR / DI / Counseling​

Pepto Bismol

DNU <12 y/o

Avoid in other viral infections in children

Tinnitus / BLACK STOOL+TONGUE

 

Aspirin / Warfarin

Valproid Acid / methotrexate

TCA / quinolones

13

Pepto Bismol for children

 

ONLY FOR ADULTS AND CHILDREN >12 y/o

 

But there is a Children's Version (calcium carbonate)

only treats Heartburn though.

14

Diatary Management of 

Diarrhea

  • BRATT diet
    • Bananas + Rice + Applesauce + Tea + Toast
      • DNU alone or for a long time
  • ​​Recommend eating:
    • Yogurt + Complex carbs / Fruits / Veggies / Lean meats
  • Avoid:
    • ​dairy / fatty foods / spicy foods / simple sugars
    • alcohol / caffeine

15

Diarrhea Recommendations

FLUID INTAKE is important

SEE MD if on OTC meds for >48 Hours

Most diarrhea is SELF LIMITING

(use non-pharm treatment first)

Double check active ingredients

16

Lactose Intolerance

Epidemiology

Most Common in:

Asians > Native americans

> African

Hispanic > Caucasian

17

Symptoms after ingestion of

LACTOSE

Ab Pain

Bloating

Flatulence

Diarrhea

bulky / frothy / watery stools

Vomiting in Adolecents

18

Tips for Lactose Intolerance

Decrease Dietary Lactose

Alternate nutrient sources for energy/protein

Dietary Enzyme Substitute (lactase)

Maintain CALCIUM + VIT D

19

Lactase

Lactaid

Digestive Enzyme

don't completely hydrolyze all dietary lactose

Liquid Lactaid can be added to milk

14 drops -> 1 quart

Refrigerate overnight

Adjust dose and lactose load to tolerance

20

Probiotics

Derived from cultured milk products

Help maintain normal GI Flora by:

inhibiting bacterial overgrowth

 

Role not coclusive

generally safe

21

Lactobacillus GG

Culturelle

Uses: Mild Viral Diarrhea

in infants/young children

also in some yogurts

 

for infectious / antibiotic-associated diarrhea

22

Lactobacillus Acidophilus

 

Used for Management / prevention of:

Acute uncomplicated diarrhea

Vaginal Infections

 

Not considered effective by FDA

for infectious / antibiotic associated diarrhea

23

Bifidobacterium  Animalis / Lactis

Activa / Align

Activa / Align

Added to yogurt

to promote intestinal transit / aid in reguarity

 

24

Bifidobacterium Infantis

Constipation / Diarrhea / Urgency / Gas / Bloating

25

Align

Dose & Indication

Bifidobacterium INFANTIS

4mg

1 Capsule Daily

 

For IBS / Constipation / DIARRHEA /

Nausea & Cramping

26

Align

ADR / CI / Counseling

Immunocompromised patients

Pregnancy / Lactation LIMITED

 

Flatulence / Bloating / Diarrhea

 

Store at ROOM TEMP / has milk products

27

Culturelle

Dose / Indication

 

Lactobacills GG

1 Dose Per Day

or BID during digestive upset or travel

 

14 day course

may be repeated once every

q4 MONTHS

28

Culturelle

ADR / CI / Counseling

Lactobaccillis GG

Immunocompromised patients

Pregnancy / Lactation limited

flatuelence / bloating / diarrhea

CAPSULE MAY BE OPENED AND MIXED WITH

COOL DRINK OR FOOD

do NOT add to WARM OR HOT foods/drink

store in cool place / room temp.

29

Lactaid

Dose / Indication

Lactase Enzyme

Original Caplet = 3000FCC 

Fast Act = 9000FCC

To help prevent GAS / BLOATING / DIARRHEA

9000 FCC (1 or 3 capsules)

with the FIRST BITE OF DAIRY FOODS

30

Lactaid

ADR / CI / Counseling

lactase enzyme

No known adverse effects

See MD if symptoms persist after dairy

 

Take with First Bite of dairy foods

Consider supplementing CALCIUM