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Patient Counseling for Diarrhea

December 23rd, 2011 | Comments Off

Patients with diarrhea may focus on the need (bra nonprescription medication to stop the frequent bowel movements. The practitioner should remind them that most episodes of acute diarrhea stop after 48 hours, and that preventing dehydration is the most important component of treating the problem. Counseling on the two-step treatment … Read entire article »

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Assessment of Diarrhea

To evaluate a patient with diarrhea, the practitioner differentiates symptoms and makes clinical judgments. This triage function is based on the patient’s responses to questions designed to help determine the cause of the specific signs and symptoms, their characteristics, and their severity. The practitioner should therefore ask the patient about vomiting, high and/or prolonged fever, and other symptoms to determine the patient’s susceptibility to complications. Persistent diarrhea, chronic diarrhea, or presence of high fever (greater than 102.2°F |39°C]), protracted vomiting, abdominal pain in patients older than 50 years, or blood or mucus in the stool precludes self-treatment and requires immediate medical referral. If none of these significant findings is present, the degree of dehydration is … Read entire article »

Complementary and Alternative Therapies

Probiotics, including several Lactobadllus species. Bifuloboctcria hulls, and Saccharomyces boulardii, are commonly used to manage or prevent acute, uncomplicated diarrhea. As normal inhabitants of the human Cl tract, these lactic acid-producing bacteria help maintain normal CI flora and reduce colonization by pathogenic bacteria. The exact mechanisms underlying the effects of these bacteria are not clear: Lactobadllus is suggested to enhance immune responses, produce antimicrobial substances, and compete with bacteria for intestinal mucosal binding sites. Evidence demonstrates that probiotic therapy, especially with Lactobadllus rhamnosus GG (but also Lactobacillus casei, Lactobadllus addophilus, and Lactobadllus rented), prevents or shortens the course of mild viral diarrhea in infants and young children rhamnosus GG therapy can shorten duration of acute infectious … Read entire article »

Pharmacologic Therapy

Although most acute nonspecific diarrhea in the United States is self-limiting, nonprescription antidiarrheal products may provide relief and will usually do no harm when used according to label instructions. Table Recommended Dosages of Antidiarrheal Agents for Acute Diarrhea lists dosage and administration guidelines for these agents. Scientific evidence that pharmacologic agents, with the exception of loperamide and Bismuth subsalicylate. reduce stool frequency or duration of disease in adults is lacking. Likewise, antidiarrheal drugs have not been shown to significantly improve clinical outcomes of acute nonspecific diarrhea in infants and children. Importantly, a change in stool consistency toward more formed stools does not necessarily indicate that antidiarrheal therapy has successfully treated the underlying problem. Comparison of Electrolyte … Read entire article »

Treatment of Diarrhea

Treatment Goals The goals of self-treatment are to (1) prevent or correct fluid and electrolyte loss and acid base disturbance. (2) relieve symptoms, (3) identify and treat the cause, and (4) prevent acute morbidity and mortality. General Treatment Approach Infectious diarrhea is often self-limiting. Symptomatic relief and correction of fluid and electrolyte loss are generally adequate for mild-to-moderate, uncomplicated diarrhea. Initial self-management for adults and children should focus on fluid and electrolyte replacement by administering commercially available oral solutions (e.g.. Pedialyte) in adequate doses. Simultaneous implementation of oral rehydration and specific dietary measures is appropriate for treating mild-to-moderate diarrheal illness. Symptomatic relief can also be achieved by using nonprescription antidiarrheal drugs, such as loperamide in carefully selected patients. … Read entire article »

Clinical Presentation of Diarrhea

The most common signs and symptoms of acute infectious diarrhea! illnesses are shown in Table Common Infectious Diarrheas and Their Treatment. Variability in the causes of diarrhea makes identification of the pathophysiologic mechanisms difficult. The etiology, and subsequently the pathophysiology, can be determined by a thorough medical history in most cases. However, a complete medical assessment, including clinical laboratory evaluation, may be required to identify the cause in a subset of patients with severe or persistent diarrhea. Diarrhea can be classified as osmotic, secretory, inflammatory, or motor, depending on the underlying pathophysiologic mechanisms that disrupt normal intestinal function. The common mechanisms of acute diarrhea are osmotic and secretory, whereas motor and exudative mechanisms commonly underlie chronic … Read entire article »

Pathophysiology of Diarrhea

The specific causes of acute diarrhea differ between developing and developed countries. In the United States, viral and food-borne diarrhea] illnesses are common; however, in the majority of cases, the causes cannot be determined. In developing countries, poor sanitation and poor hygiene lead to infectious diarrhea caused by parasites, bacteria, and viruses. Bacterial causes are as common as viral infections in these countries. Table Common Infectious Diarrheas and Their Treatment highlights some of the common viral, bacterial, and protozoal diarrheas and their treatment. Epidemiologic factors that increase the risk for particular infectious diarrhea] diseases or their spread include attendance or employment at day care centers, occupation as a food handler or caregiver, congregate living conditions (e.g., … Read entire article »

Patient Counseling for Constipation

Because laxative products are both widely used and abused, clinicians can provide a valuable service by educating patients about the appropriate use of laxatives. Proper education about laxative products and wise advice on product selection and use are particularly crucial for children and older patients. Before recommending a laxative product, the clinician should first discuss the nondrug measures for treating constipation. Pregnant women and children, especially, should be counseled on proper diet, ade- quate fluid intake, and reasonable exercise. Individuals may not understand the importance of these factors in the development of constipation and how simple lifestyle changes can restore relatively normal bowel function without laxative use. If a laxative is needed, the health care provider … Read entire article »

Patient Factors

Laxative products are available in a wide array of dosage forms, most of them for oral use. This variety probably yields the most benefits for pediatric and geriatric patients. Many of the dosage forms enhance patient acceptability and perhaps make laxative use more pleasant. However, laxatives available as chewing gum, wafers, effervescent granules, and chocolate tablets may not be thought of as drug products; therefore, they are more likely to be misused and abused. Enemas and suppositories are popular nonoral dosage forms used for laxative administration. Routine use oflaxative enemas includes preparing patients for surgery, child delivery, and gastrointestinal radiologic or endoscopic examinations, as well as for treating certain cases of constipation. The enema fluid determines … Read entire article »

Special Populations

Children A number of factors can alter a child’s bowel habits, including unavailable toilet facilities; emotional distress; febrile illness: chronic medical conditions (e.g., cystic fibrosis and hypothyroidism); family conflict: dietary changes (e.g.. switching from human to cow’s milk); or a change in daily routine or environment. Some children are poor or picky eaters, which may contribute to the development of constipation due to inadequate bulk and fluids in the diet. Constipation associated with an organic or pathologic etiology is uncommon in children.” Bowel movement patterns vary widely in children; therefore constipation can be a complex problem that is often difficult to detect and manage. Selected Laxative Products Trade Name Primary Ingredients Bulk-Forming Laxatives Citrucel … Read entire article »

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