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Constipation & Diarrhea F12 (1)

Fluid and electrolyte management dietary changes

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Fluid and electrolyte management Dietary changes Pharmacologic therapy Goals Correct/prevent fluid and electrolyte disturbances Symptom relief Identify and treat cause Prevent complications Many cases of diarrhea are self-limiting (usually resolve in 24-72 hr) Patients with severe diarrhea should be referred to health care provider
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Oral Rehydration Solutions (ORS) Examples Pedialyte®, Enfalyte®, Rehydralyte® Preferred treatment for mild to moderate diarrhea Contain Carbohydrate (glucose/dextrose) Necessary for absorption of electrolytes Electrolytes (Na + , Cl - , citrate, K + ) 2 phases of using ORS Replacement therapy Maintenance therapy
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Oral Rehydration Solutions (ORS) Replacement Therapy Quickly replaces water and electrolytes to restore normal body composition Contain 75-90 mEq/L of Na + Mild-moderate diarrhea Children 1 mo-5 yr: 50-100 ml/kg over 3-4 hr Adults: 2-4 L over 3 hr Don’t necessarily need to give ORS if can maintain adequate intake of fluids (e.g. clear juices, soups, sports drinks [Gatorade])
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Oral Rehydration Solutions (ORS) Maintenance Therapy To maintain normal body composition Contain 40-60 mEq/L of Na + Children 1 mo-5 yr: 10 ml/kg of ORS for each subsequent loose stool
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Diet May discontinue solid food and use clear liquids for ~24 hours Normal diet should be resumed once patient is rehydrated Avoid fatty foods, foods high in simple sugars, spicy foods, and caffeine BRAT diet is NOT recommended Insufficient calories
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Pharmacological Therapy Keep in mind that antibiotics may be required in certain cases of infectious diarrhea caused by bacteria or protozoa (not for viral) OTC antidiarrheals used to provide symptomatic relief Loperamide Bismuth subsalicylate Lactase enzyme preparations Probiotics
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Loperamide (Imodium A-D) MOA: Synthetic opioid agonist that stimulates the μ -opioid receptors in intestine intestinal motility and GI secretion Role in therapy: Often considered first-line therapy (acute diarrhea [including traveler’s diarrhea]) Should not be used if C. diff is suspected Can cause toxic megacolon Should not be used in children < 6 yr
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Loperamide (Imodium A-D) Dosing: 4mg initially; 2mg after each subsequent loose stool Should not exceed 8 mg/day Should not use for >48 hr Adverse effects Constipation
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Bismuth Subsalicylate Kaopectate®, Pepto-Bismol® MOA: Reacts with HCl in stomach to form bismuth oxychloride and salicylic acid Bismuth oxychloride has antimicrobial effects Not absorbed systemically Salicylic acid has antisecretory effects Systemically absorbed Role in therapy: Acute diarrhea (including traveler’s diarrhea) Should not be used in children < 12 yr Reye’s syndrome Do not use in patients with aspirin allergy Do not use in pregnant females Should not use for > 48 hr
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Bismuth Subsalicylate Adverse effects Black stool or darkening of the tongue Harmless
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Lactase Enzyme Preparations Lactaid® Useful in patients with are lactose intolerant Can be taken with dairy products to prevent osmotic diarrhea
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Probiotics Definition
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