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. Normal function of the alimentary tract is often restored in 24 to 72 hours without additional treatment. Severe diarrhea constitutes a medical emergency, especially in young children, and requires immediate referral for medical evaluation and treatment. Initial management with intravenous (IV) fluid therapy is necessary until perfusion and mental status improve.

Nonpharmacologic Therapy Fluid and Electrolyte Management

Correction of fluid loss and electrolyte imbalances is important, and can be accomplished by oral or IV therapy. Rehydration using oral rehydration solution (oral rehydration solution) is the preferred treatment for mild-to-moderate diarrhea. This approach is as effective as IV therapy in managing fluid and electrolytes in children with mild-to-moderate dehydration secondary to diarrhea. Because the gastrointestinal glucose-sodium cotransport mechanism is not adversely affected by most diarrheal diseases, oral rehydration solutions containing low concentrations of glucose or dextrose (2%-2.5%) can be useful in managing fluid and electrolyte balance. The sugar molecules provide very little caloric support, but they facilitate intestinal sodium and water absorption. Maximal sodium absorption occurs at a molar glucose-to-sodium ratio close to 1. In mild-to-moderate diarrhea, practitioners can safely recommend an oral rehydration solution.

According to the patient’s fluid and electrolyte status, oral treatment may be carried out in two phases: rehydration therapy and maintenance therapy. Rehydrarion over 3 to 4 hours quickly replaces water and electrolyte deficits to restore normal body composition. In the maintenance phase, electrolyte solutions are given to maintain normal body composition, and adequate dietary intake is reestablished. Although oral rehydration solutions generally are recommended for use in adults with diarrhea, there is scant evidence to support this recommendation, oral rehydration solutions may not provide any real benefit to otherwise healthy adults with mild diarrhea who can maintain an adequate fluid intake during the episode of diarrhea; for these patients, fluid and electrolyte status can be maintained by increasing intake of fluids, such as clear juices, soups, or sports drinks. Rehydration using an oral rehydration solution has no effect on the duration of diarrhea.

A variety of oral rehydration solutions are available. Most products are premixed solutions; a few are available as dry powders of glucose and electrolytes that require addition of water. The premixed products are preferred for use in children because they are safe and convenient; improper mixing of dry powders by caregivers has led to patient fluid and electrolyte complications and injury. The World Health Organization (WFIO) and United Nations Children’s Fund (UNICEF) recommend use of an oral rehydration solution containing 75 mEq/L of sodium. This oral rehydration solution significantly reduces the need for unscheduled IV therapy, stool output, and the incidence of vomiting in children with noncholera diarrhea; this formulation is also as effective as the previous formulation in children with cholera. This oral rehydration solution is also effective in adults with cholera, although transient, asymptomatic hyponatremia may develop. Rehydration solutions available in the United States contain 75 to 90 mEq/L of sodium: maintenance oral rehydration solutions contain 40 to 60 mEq/L of sodium, oral rehydration solutions have been improved with the development of cereal-based products that use complex carbohydrates (e.g., rice syrup solids) instead of glucose. Complex carbohydrates are convened into glucose at the intestinal brush border and provide more cotransport molecules while reducing the osmotic load of the oral rehydration solution. Cereal-based oral rehydration solution therapy potentially reduces stool volume by 20% to 30% in children with cholera, but this therapy may not significantly alter stool volume in children with noncholera acute diarrhea.

Selected Oral Rehydration Products

Trade Name	Osmolarity	Calories	Carbohydrate	Electrolytes
WHO-oral rehydration solution	245 mOsm/L	46 cal/L	gastrointestinalucose 13.5 g/L	Sodium 75 mEq/L; chloride 65 mEq/L; citrate 30 mEq/L; potassium 20 mEq/L
CeraLyte 50 Powder Packets	<200 mOsm/L	160cal/L	Rice starch polymers 40 g/L; sucrose 10 g/L	Sodium 50 mEq/L; chloride 40 mEq/L; citrate 30 mEq/L; potassium 20 mEq/L
CeraLyte 70 Powder Packets	<230 mOsm/L	160 cal/L	Rice starch polymers 40 g/L	Sodium 70 mEq/L; chloride 60 mEq/L; citrate 30 mEq/L; potassium 20 mEq/L
CeraLyte 90 Powder Packets	260 mOsm/L	160 cal/L	Rice starch polymers 40 g/L	Sodium 90 mEq/L; chloride 80 mEq/L; citrate 30 mEq/L; potassium 20 mEq/L
Enfalyte Solution	167mOsm/L	126 cal/L	Rice syrup solids 30 g/L	Sodium 50 mEq/L; chloride 45 mEq/L; citrate 34 mEq/L; potassium 25 mEq/L
Pedialyte	249 mOsm/L	100 cal/L	Dextrose 20 g/L; fructose 5 g/L	Sodium 45 mEq/L; chloride 35 mEq/L; citrate 30 mEq/L; potassium 20 mEq/L
Pedialyte Freezer Pops		6.25 cal/L	Dextrose 25 g/L	Sodium 45 mEq/L; chloride 35 mEq/L; citrate 30 mEq/L; potassium 20 mEq/L
Rehydralyte Solution	304 mOsm/L	100 cal/L	Dextrose 25 g/L	Sodium 75 mEq/L; chloride 65 mEq/L; citrate 30 mEq/L; potassium 20 mEq/L

All available premixed solutions are equally sate and effective; there is no evidence that one product is clinically superior to another in effecting rehydration.

A variety of common household oral solutions have also been used for oral rehydration and maintenance. Although these solutions may be sufficient to manage mild, self-limiting diarrhea in some patients, they should be avoided if dehydration or moderate-to-severe diarrhea is present. Unlike commercial oral rehydration solutions. these remedies are not formulated on the basis of the physiology of acute diarrhea. The inappropriately high carbohydrate content and osmolality of these solutions can worsen diarrhea, and their low sodium content can contribute to the development of hyponatremia. Sports drinks may be used in older children (older than 5 veal’s) and adults it additional sources of sodium, such as crackers or pretzels, are used concomitantly. Colas, ginger ale. apple juice, sports drinks, and similar products are not recommended for infants and young children (6 months to 5 years of age) with diarrhea. Tea, another popular household remedy, is also inappropriate for children because of its low sodium content. Chicken broth is not recommended because of its inappropriately high sodium content.

Dietary Management

The traditional dietary approach to acute diarrhea has been the withdrawal of feedings and initiation of clear liquids, with a slow reintroduction of feedings over several days. However, oral intake does not worsen the diarrhea, clinically significant nutrient mal-absorption is uncommon in acute diarrhea, and bowel rest is generally not necessary. On the contrary, during acute diarrhea, patients are able to absorb 80% to 95% of dietary carbohydrates. 70% of fat and 75% of the nitrogen from protein. Early refeeding in combination with maintenance oral rehydration improves outcomes of acute diarrhea in children by reducing duration of the diarrhea, reducing stool output, and improving weight gain. It is inappropriate to withhold food for longer than 24 hours. A normal, age-appropriate diet should be reintroduced once the patient has been rehydrated. which should take no longer than 3 to 4 hours to accomplish. Most infants and children with acute diarrhea can tolerate full-strength breast milk and cow milk. The familiar BRAT diet (bananas, rice, apple-sauce, and toast) is not recommended; it provides insufficient calories, protein, and fat, especially in situations of strict or prolonged use. Patients (or their parents) should be advised to avoid tatty foods, foods rich in simple sugars that can cause osmotic diarrhea, and spicy foods that may cause gastrointestinal upset. Caffeine-containing beverages should also be avoided, given that caffeine can increase cyclic adenosine monophosphate levels, which promote fluid secretion and may worsen diarrhea. There is no evidence that fasting or dietary modification influences outcomes of acute diarrhea in adults; however, similar guidelines can be applied if a normal diet is not tolerated.

Preventive Measures

Infectious diarrhea, especially acute viral gastroenteritis, often occurs in congregate living conditions such as day care centers and nursing homes through person-to-person transmission. Isolating the individual with diarrhea, washing hands, and using sterile techniques are basic preventive measures that reduce the risk among such populations and their caregivers. Strict food handling, sanitation, and other hygienic practices help control transmission of bacteria and other infectious agents.

Short-term bismuth subsalicylate (Bismuth subsalicylate) prophylaxis is frequently recommended to provide protection against travelers’ diarrhea; however. FDA has deemed available data insufficient to support prophylactic use of Bismuth subsalicylate. Antibiotics with reliable activity against enteropathogens in the region of travel provide effective prophylaxis. However, prophylactic antimicrobial agents are not currently recommended for most travelers. Prophylactic antibiotics may be considered for short-term travelers who are high-risk hosts (e.g., immunosuppressed patients) or for those critical trips during which even a short bout of diarrhea could impact the purpose of the trip.

This post has been viewed 119 times.

Related posts:

1. Treatment: Diarrhea Buy Imodium Online With Low Price Support Drug Guide: purchase the best medicine from our sponsor, online pharmacy, where you can place an order and buy cheap drugs at low prices without a prescription, worldwide delivery. Prices for Imodium according to the dosage forms and number of pills. The more pills in a package, the...
2. Diarrhea: Treatment Buy Imodium Online With Low Price Support Drug Guide: purchase the best medicine from our sponsor, online pharmacy, where you can place an order and buy cheap drugs at low prices without a prescription, worldwide delivery. Prices for Imodium according to the dosage forms and number of pills. The more pills in a package, the...
3. Patient Counseling for Diarrhea Buy Imodium Online With Low Price Support Drug Guide: purchase the best medicine from our sponsor, online pharmacy, where you can place an order and buy cheap drugs at low prices without a prescription, worldwide delivery. Prices for Imodium according to the dosage forms and number of pills. The more pills in a package, the...
4. Therapy Buy Imodium Online With Low Price Support Drug Guide: purchase the best medicine from our sponsor, online pharmacy, where you can place an order and buy cheap drugs at low prices without a prescription, worldwide delivery. Prices for Imodium according to the dosage forms and number of pills. The more pills in a package, the...
5. Secretory Diarrhea Buy Zofran Online With Low Price Support Drug Guide: purchase the best medicine from our sponsor, online pharmacy, where you can place an order and buy cheap drugs at low prices without a prescription, worldwide delivery. Prices for Zofran according to the dosage forms and number of pills. The more pills in a package, the...

Both comments and pings are currently closed.

Comments are closed.