DIARRHEA-TREATMENTS
Diarrhea is a frequent disturbing physiologic event in our routine life. It is one of the body languages by which the body tries to express that some unwanted things have been ingested into it. It is an involuntary action of expelling unwanted things out by our bodies without our concern.
Hence diarrhea can be defined as an abnormal increase in the frequency and loosening of the stools.
In general, the amount of stool may increase to above 200 gm or ml/day and its water content increased to above 60% to 99%.
Diarrhea persists due to some disturbing physiologic factor prevents or blocks the absorption of the water content of the stool by the small intestine.
Classifications of Diarrhea
1.By Mechanism of Actions:-
a. Osmotic Diarrhea occurs when a nonabsorbable substance present in the foods pulls excess water into the intestinal lumen.
(e.g.)1.Overeating
2.Ingestion of nonabsorbable substances such as sorbitol, glycerin, etc.
3.Enzyme deficiencies (e.g.)Deficiency of Lactase a disaccharidase enzyme to breakdown the nonabsorbable disaccharide sugar Lactose into absorbable monosaccharides.
b.Secretory Diarrhea occurs when the intestinal wall is damaged results in increased secretion and decreased absorption of water and electrolytes by the intestine.
(e.g.)
1.Bacterial endotoxins (E.coli;Vibrio cholerae,Shigella,S.aureus)
2.Bacterial infections (Shigella, Salmonella)
3.Viral infections (Rotavirus, Norwalk virus)
4.Protozoal infections (Giardia lamblia, Entamoeba histolytica)
5.Miscellaneous causes such as inflammatory bowel disease, and medications like prostaglandins, antibiotics, colchicine, and chemotherapeutic drugs.
c.Motility Disorders occurs when there is an insufficient contact of the stool with the intestinal wall so that less water is absorbed by the intestine
(e.g.)
1.Irritable bowel syndrome, scleroderma, diabetic neuropathy, gastric/intestinal incompatibility, and vagotomy.
2. Medications that can induce motility disorders include cholinergic agents (metoclopramide, bethanechol,), digitalis quinidine, and antibiotics.
Antibiotics cause diarrhea by intestinal irritations, increased bowel motility, and destroying intestinal bacterial flora. These symptoms can be minimized by taking antibiotics after food.
2.By etiology
a.Acute Diarrhea(Less than 2 weeks)
1.Infections
A.Viral infections due to Rota and Norwalk viruses
Rotavirus usually affect children under 2 years of age. The infection onset by 1 to 2 days and lasts for 5 to 8 days. Vomiting, fever, and mild dehydration are common symptoms. There is usually no pus or blood in the stool
Norwalk virus usually affects older children and adults. It has an onset of 1to2 days and lasts for 24 to 48 hours. Mild fever, vomiting, and dehydration are the symptoms and without pus or blood in the stool.
B.Bacterial Infections
Due to the consumption of contaminated water and food and the onset occur after 8 to several days.
Toxigenic Bacteriae These includes E.coli;V.cholerae;S.aureus.which spread their endotoxins. Symptoms are excretion large watery and greasy stools leads to severe dehydration.
Invasive Bacterias such as E.coli; Shigella; Salmonella; Campylobacter; and Clostridium difficile ane invading the intestinal mucosa. This results in dysentery like diarrhea which is experienced by an extreme urgency to defecate, stomach cramping, tenesmus(a false feeling of passing stool), fever, chills, blood, or pus in the stool.
Protozoa such as G.lamblia; E.histolytica; and Cryptosporidium causes explosive foul-smelling large volume of watery stool. This is due to the extreme invasion of the intestine by destroying its villi. Symptoms are severe loss of water and extreme dehydration. Though it is self-limiting it may persist for several months until complete eradication of the organisms.
C. Diet-induced diarrhea is commonly induced by food allergies, high fiber diets, fatty or spicy foods, large amounts of stimulants like caffeine, or milk. Avoiding such foods are the best treatment
TREATMENTS
A.Non-Medical Treatments
It is most advisable normal feeding of food or milk should not be stopped as the recent researches show that a normal diet or breastfeeding during diarrhea does not make it worse and may actually improve diarrhea.
Fluids in large quantities should be taken as electrolyte solution in order to prevent dehydration in acute diarrheal episodes. Oral and intravenous rehydration should be engaged as per the severity.
A homemade rehydration solution can be prepared as follows
Sodium chloride(Table salt) ---0.5 teaspoon
Potassium chloride ---0.25 tsp
Sodium bicarbonate (backing
salt) ---0.5 tsp
Glucose ---2 tablespoon
Water add up to 1 liter.
Recommended dosages as follows
Adult (= or > 10 yrs) ---2000to3000ml/day
Children (5 to 10 yrs) ---1000to2000ml/day
Children (below 5 yrs) ---40to75ml/kg for -
- the first 6 hrs.or -
5 to 10 ml every 10 to 15 min for 30 min then-
15 to 20 ml every 10 to 15 mins for 30 mins then-
30 ml every 30 minutes to complete the first 6 hours
60 ml (1/4 cup) every 30 minutes for the next 12 hours
Fluids to be avoided include hypertonic fluids such as apple juice; powdered drink mixes; gelatin water and carbonated drinks.
B.Medical Treatments
Up to date, the American FDA has allowed three agents as a category -I (i.e.safe and effective) medicines such as activated attapulgite (Aluminium and Magnesium silicates); calcium polycarbophil and loperamide.
1.Antiperistaltic drugs
These medicines acting by reducing the peristaltic movements of the gut. The frequency of the bowel movement is decreased and stool consistency is increased.
This medication is contraindicated in bacterial diarrhea as it prevents the clearance of the bacteria from the body and opens the way for the organism to enter into the system. But much information tells that this not serious and often proves no harm however care should be taken during the colitis diarrhea as it may cause serious megacolon.
Children <2 years should not be treated with these medications.
The following medicines are dispensed under prescription such as opiates related diphenoxylate/atropine (Lomotil); difenoxin/atropin(Metofen) as antiperistaltic agents.
Loperamide(Imodium); Kaopectate-II; are the nonprescription drugs.
Antiperistaltic drugs should not be used for more than 48 hours.
Side effects
1.Abdominal Pain
2.Stomach discomfort or distention
3.Drowsiness
4.Dizziness
5.Dry mouth
Dosage
For adults 4 mg followed by 2 mg after each loose motion and not exceed 16 mg/day
For children 1 to 2 mg three times daily as per the weight and age.
2.Adsorbents
These drugs adsorb the toxins, bacteria gases, and water content of the stool on its surface of exposure. They are not absorbed systemically.
They are used only to give symptomatic relief and not a cure for severe symptoms. They should be given in large doses immediately following a loose stool.
a.Activated attapulgite. For adults a dose of 1200 mg after each stool.
For children 300 to 600 mg after each stool
Side effects are almost nill
b. Calcium Polycarbophil For adult 1 gm 1 to 4 times daily
For children 0.5 gms 1 to 4 times daily.
Side effects are nill
3.Miscellaneous
1.Bismuthsubsalicylate for an adult 2 tablets or 30 to 60ml every hour as needed to a maximum of 8 doses per day. The child's dose is half of the adult dose.
Side effects
It can cause harmless grayish black stools or tongue and ringing in the ear.
Contraindicated in children recovering from chickenpox, or flu because of the possible Rye's syndrome.
2. Lactobacillus is used to replace the normal bacterial flora.
3. Lactase a disaccharidase they can breakdown diarrhea producing nonabsorbable disaccharides like lactose (in milk) into absorbable glucose and galactose.
The adult dose is 1 to 2 capsules taken with dairy products
4. Anticholinergics like atropine and scopolamine are producing antidiarrheal effects by slowing the bowel movements and increasing fluid absorption.
Side effects are dry mouth, blurred vision, urinary retention, and tachycardia.
5. Antiinfectives The infective diarrheas can be treated by the administration of antibiotics
Ciprofloxacin 500 mg twice/day
Doxycycline 100mg twice/day
Norfloxacin 400mg twice/day
Tetracycline 250mg 4times/day
Septran-DS 1 tab 2 times/day
The above are treatments should be under a doctors supervision
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