Diarrhoea

Question 1

What are the symptoms of diarrhoea?

Answer 1

Increased frequency of bowel evacuation
Associated with abnormally soft or watery faeces 
Abdominal cramps
Flatulence 
Nausea
Weakness may also occur

Question 2

When to refer a pt with diarrhoea?

Answer 2

1. Babies <3 months refer immediately
2. Children <1 years - duration >1 days
3. People with diabetes duration >1 day
4. Adults and children - duration >3 days
5. Children <3 years - duration >2 days
6. N/V and fever - increase risk of dehydration
7. signs of dehydration - dry skin, sunken eyes, dry tongue, drowsiness, less urine
8. if people in close proximity suffer - could be infective
9. blood or mucus in the stools - carcinoma or gastric ulcer
10. alternating constipation and diarrhoea in elderly pts - facel impaction
11. longstanding change in bowel habit in pts >50 years with weight loss
12. drugs like Mg salts, antibiotics, digoxin, diuretics, iron , laxatives, NSAIDS, SSRIs
13. regular purchase of morphine/codeine

Question 3

what is first line tx?

Answer 3

ORT - sachets of powder or already formulated liquids containing sodium, glucose or K+

Question 4

what is second line tx?

Answer 4

Loperamide 2mg - not recommended for children under 12, P/BF - best to use in conjunction with oral rehydration
Loperamide has high affinity for opiate receptors in the gut wall leading to reduce motility

Question 5

What are alternatives?

Answer 5

1. Kaolin - absorbs water as well as adsorbs toxins and bacteria
2. Attapulgite, bismuth salicylate
3. morphine

Question 6

Name OTC preps

Answer 6

Dioralyte
Imodium
Pepto-Bismol

Question 7

What are counselling points?

Answer 7

1. do not reconstitute fruit/fizzy/sugary drinks or boiling water with the powder - boil and cool water first - it can be kept in the fridge for 24 hours
2. bismuth results in salicylate absorption - avoid in those hypersensitive to aspirin
3. Drink plenty of fluids but avoid drinks high in sugar as these can prolong diarrhoea
   Avoid milky drinks as lactose intolerance occurs due to damage to cells lining intestine
4. Formula feeds should be diluted to quarter-strength and built back up to normal over 3 days
5. Babies should be fed more frequently than normal and feeds supplemented with ORT

Question 8

What are ways to avoid contracting or spreading infective diarrhoea?

Answer 8

Always wash hands with soap and dry in air with clean towel before eating
avoid shared drinking water
eat fresh foods, no uncooked meat
Avoid shellfish and fish unless fresh

Question 9

What age can bismuth be given to?

What age can morphine salts be given to?

Answer 9

> 16 years

> 12 years

Question 10

Is loperamide

bismuth and morphine okay in P and BF?

Answer 10

Loperamide - SAFE in both
bismuth - avoid in BF - reyes syndrome as it contains salicylate
Morphine salts - okay!