Lecture 2- Diarrhea

Question 1

How many days would you give for acute diarrhea ?

Answer 1

14 days

Question 2

What are the different types of diarrhea ?

Answer 2

secretory , osmotic, Inflammatory, increased gut motility

Question 3

What are the possible red flags of diarrhea ?

Answer 3

Fever (>38.5℃)
Blood or abnormal mucus in stools
Severe abdominal pain/cramping
Severe diarrhea (>6 loose stools per day for greater than 48 hours)
Diarrhea > 7 days
Signs of debilitating dehydration
Clostridium difficile infections
Overflow diarrhea due to fecal impaction (bowel obstruction

Young Children / Frail / Pregnancy / CKD/ DM/ immunocompromised

Question 4

What are the NON-PHARM for the Tx of Diarrhea ?

Answer 4

ORS
Hydration for 24hrs
Avoiding the triggers
Avoid fruit juice _ carbonated drinks
Stop ingestion of poorly absorbed carbo ( sorbitol/ mannitol)
BRAT – not recommended

Question 5

Why does ORS work ?

Answer 5

optimize the CGLT2 channels to get more NA+ and glucose to pull in water through the channel

Question 6

What is the recommended dose for WHO - ORS ?

Answer 6

245 mosm/L + 20 CHO g/l

Question 7

What are the main ingredients of lomotil ?

Answer 7

diphenoxylate + atropine

Question 8

What are the indication for lomotil ?

Answer 8

GI motility –> diarrhea
prevent abuse

Question 9

What are the CONTRAINDICATIONS for lomotil ?

Answer 9

pregnancy
C. difficile
dry mouth / blurry vision / urinary retention / constipation

Question 10

What is the MOA of attapulgite ?

Answer 10

absorb water, nutrients, toxins and bacteria

Question 11

What is the use of psylluim in diarrhea ?

Answer 11

Bulking agent by absorbing liquid and making it firm

Question 12

What is the DOSE of bismuth salicylate ?

Answer 12

524 mg ( every 0.5 -1 hour) prn –> MAX 4.2 g/day

Question 13

What are the indication for pepto bismol ?

Answer 13

Traveler Diarrhea

Question 14

What are the SE of bismuth salicyclate ?

Answer 14

dark stool, black tongue , tinnitus

Question 15

what can possibly happen with <2 yo takes bismuth salicylates ?

Answer 15

Reye syndrom

Question 16

What is something that we should be careful when giving cholestyramine for diarrhea ?

Answer 16

it can bind to drugs
space by 4-6 hours

Question 17

Whick Abx can be given to prevent/Tx travellers diarrhea ?

Answer 17

Fluoroquinolones, azithromycin, rifaximin

Question 18

What is octreotide, lanreotide ?

Answer 18

somatostatin analogue –> inhibit hormones for CHRONIC diarrhea from chemo or short bowel syndrome

Question 19

What is the indication for clonidine ?

Answer 19

a2 agonist w/ opioid withdrawal , diabetic autonomic neuropathies

Question 20

What can you do if the diarrhea does not improve within 48 h after initial Tx ?

Answer 20

provide loperamide for 24 h

Question 21

What should be avoided in CHRONIC diarrhea ?

Answer 21

lomotil, bismuth subsalicylate

Question 22

Which of the probiotics had good evidence for its efficacy in diarrhea Tx in children ?

Answer 22

Lactobacillus

Question 23

What are the indication for probiotics ?

Answer 23

Diarrhea prevention and treatment, infectious
diarrhea, traveler’s diarrhea (prevention and treatment), antibiotic-associated diarrhea, and IBS

Question 24

What is the ideal dose for probiotics ?

Answer 24

10^9 to 10^10 CFU

Question 25

What does the evidence say about separating Abx & probitocs ?

Answer 25

WEAK EVIDENCE

Question 26

What is the BRAT diet ?

Answer 26

combo of simple + complex carbo

Question 27

Simple or complex carbohydrates ?
Banana
White Rice/ toast
Applesauce

Answer 27

Banana –> complex
Applesauce –> complex
white rice/toast –> simple