<?xml version="1.0" encoding="UTF-8"?><rss version="0.92">
<channel>
	<title>Laxatives</title>
	<link>http://laxativedrugs.com</link>
	<description>Laxative Drugs &#124; Treatment of Constipation</description>
	<lastBuildDate>Fri, 23 Dec 2011 06:41:27 +0000</lastBuildDate>
	<docs>http://backend.userland.com/rss092</docs>
	<language>en</language>
	<!-- generator="WordPress/3.0.1" -->
<xhtml:meta xmlns:xhtml="http://www.w3.org/1999/xhtml" name="robots" content="noindex" />

	<item>
		<title>Patient Counseling for Diarrhea</title>
		<description><![CDATA[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 of dehydration and the need for dietary management should follow. For infants and children, educating parents and caregivers on the appropriate use of an OKS (including appropriate volumes to administer, rates of administration, and use in vomiting) and of dietary management is very important in preventive care. For patient safety reasons, premixed solutions are preferred. Importantly, if dry powder oral rehydration solution is selected, the practitioner should give parents (or caregivers) explicit directions for mixing and verify that they understand the directions. For families with infants, the Centers for Disease Control and Prevention recommends a home supply of oral rehydration solution. because early administration of an oral rehydration solution at home is vital if hospitalization is to be avoided. If travelers are using oral rehydration solution dry powder in developing countries, potable water should be used to reconstitute the powder. If a nonspecific antidiarrheal is recommended, the practitioner should review label instructions with the patient. The practitioner should stress an appropriate dosage on the basis of the patient&#8217;s age and weight, the maximum number of doses per 24 hours, and the auxiliary administration instructions. The practitioner should also explain potential drug interactions, side effects, contraindications, and the maximum duration of treatment before seeking medical help. The box Patient Education for Diarrhea contains specific information to provide patients. Patient  education  for Diarrhea The primary objective of self-treatment is to prevent excessive fluid and electrolyte losses. For most patients, carefully following product instructions and the self-care measures listed here will help ensure optimal outcomes. Nondrug Measures Infants and Children 6 Months to 5 Years For mild-to-moderate diarrhea, indicated by three to five unformed bowel movements per day, give the child or infant an oral rehydration solution (oral rehydration solution) at a volume of 50-100 ml Vkg of body weight over 2-4 hours to replace the fluid deficit. Give additional oral rehydration solution to replace ongoing losses. Continue to give the solution for the next 4 to 6 hours or until the child is rehydrated. If the child is vomiting, give 1 teaspoon of oral rehydration solution every few minutes. If the child is not dehydrated, give 10 ml/kg or one-half to 1 cup of the oral rehydration solution for each bowel movement, or 2 mL/kg for each episode of vomiting. As an alternative, to replace ongoing fluid losses, children weighing less than 10 kg should be given 60-120 mL of oral rehydration solution for each episode of vomiting or diarrheal stool, and children weighing more than 10 kg should be given 120-240 mL for each episode of vomiting or diarrheal stool. After the child is rehydrated, reintroduce food appropriate for the child&#8217;s age, while also administering an oral rehydration solution as maintenance therapy. If breast-feeding an infant with diarrhea, continue the breastfeeding. If the infant is bottle-fed, consult your doctor or pediatrician about substituting a milk-based formula with a lactose-free formula. Give children complex carbohydrate-rich foods, yogurt, lean meats, fruits, and vegetables. Do not give them fatty foods or sugary foods. Sugary foods can cause osmotic diarrhea. Do not withhold food for more than 24 hours. Adults and Children Older Than 5 Years For mild-to-moderate dehydration, indicated by a 3%-9% drop in body weight or three to five unformed stools per day, drink 2-4 liters of an oral rehydration solution over 4 hours. If not dehydrated, drink one-half to 1 cup of oral rehydration solution or fluids after each unformed bowel movement. If you have no medical conditions, you may consume sport drinks, diluted juices, salty crackers, soups, and broths until the diarrhea stops. Do not withhold food for more than 24 hours. Nonprescription Medications See Table 17-6 for dosages of loperamide and bismuth sub-salicylate. Loperamide Note that loperamide can cause dizziness and constipation. Do not take this agent if you are taking sedatives, antianxiety drugs, or other antidepressants. Do not give this agent to children 2 years of age or younger. Loperamide is not recommended for children younger than 6 years, except under the supervision of a primary care provider. If loperamide is not effective in treating your diarrhea (if no clinical improvement is observed in 48 hours), check with your primary care provider or pharmacist about using a different nonprescription medication. You may have a bacterial diarrhea or pseudomembranous colitis; these conditions require specific antibiotic therapy that loperamide cannot treat. Bismuth Subsalicylate Note that bismuth subsalicylate can cause a dark discoloration of the tongue and stool. Do not take this agent if you are taking tetracyclines, quinolones, or medicines for gout (uricosurics). Do not give this agent to children younger than 12 years. Do not give this agent to children or teenagers who have or are recovering from influenza or chicken pox. Reye&#8217;s syndrome, a rare but serious condition, could occur. Do not give this agent to patients with acquired immunodeficiency syndrome. Do not take this agent if you are sensitive to aspirin, have a history of gastrointestinal bleeding, or have a history of problems with blood coagulation. If the diarrhea has not resolved after 72 hours of initial treatment, see your primary care provider. Monitor for excessive number of bowel movements, signs of dehydration, high fever, or blood in the stool. If any of these complications are present, discontinue bismuth subsalicylate and consult your primary care provider. Evaluation of Patient Outcomes for Diarrhea Many patients have mild-to-moderate diarrhea that is generally self-limiting within 48 hours. Mild-to-moderate diarrhea is managed with oral rehydration therapy, symptomatic drag therapy, and dietary measures. The patient should be monitored for dehydration by measuring body weight, vital signs, and mental alertness. With effective symptomatic relief, the patient can expect reduced frequency and normal consistency of stools, as well as relief of generalized symptoms such as lethargy and abdominal pain. As the diarrheal episode clears, the appetite will return to normal and the diet can be advanced to a regular diet. Medical referral is necessary if any of the following signs and symptoms occur before or during treatment: high fever, worsening illness, bloody or mucoid stools, diarrhea continuing beyond 48 hours, or signs of worsening dehydration (e.g., low blood pressure, rapid pulse, or mental confusion). Also, medical referral is advised for infants, young children, frail patients of advanced age, and patients with chronic illness at risk from secondary complications (e.g., diabetes mellitus). Key Points for Diarrhea Limit the self-treatment of diarrhea to patients with acute diarrhea who [...]]]></description>
		<link>http://laxativedrugs.com/index.php/diarrhea/patient-counseling-for-diarrhea</link>
			</item>
	<item>
		<title>Assessment of Diarrhea</title>
		<description><![CDATA[To evaluate a patient with diarrhea, the practitioner differentiates symptoms and makes clinical judgments. This triage function is based on the patient&#8217;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&#8217;s susceptibility to complications. Persistent diarrhea, chronic diarrhea, or presence of high fever (greater than 102.2°F &#124;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 the next important assessment; the practitioner should ask about the nature and amount of fluid intake. Severity of dehydration can be accurately assessed by evaluating changes in body weight. For example, in children, mild dehydration is associated with a 3% to 5% loss of body weight, whereas severe dehydration is associated with a loss of more than 9%. However, the patient (or the parent) seldom knows the exact premorbid weight for comparison, and distinguishing between mild and moderate dehydration may be difficult. The initial assessment of a pediatric patient should also seek to determine plausible causes of the symptoms. The common symptoms of acute gastroenteritis (e.g., vomiting, loose stools, and fever) are nonspecific findings associated with many other childhood diseases (e.g., acute otitis media, bacterial sepsis, meningitis, pneumonia, and urinary tract infections). This information is key to recommending a proper course of action, which may include self-treatment or referral to a primary care provider. A complete medication history must be assessed before a product is selected. Physical assessment of a patient with complaints of diarrhea can provide information useful in assessing severity of the diarrhea. Checking skin turgor and moistness of oral mucous membranes will help determine the degree of dehydration. Vital signs (e.g.. pulse, temperature, respiration, and blood pressure) are important indicators of illness severity and should be routinely measured. Symptoms of moderate-to-severe dehydration may include postural (orthostatic) hypotension, defined as a drop in the systolic and/or diastolic pressure of greater than 15 to 20 mm Hg on moving from a supine to an upright position. Normally, the diastolic pressure remains the same or increases slightly, and the systolic pressure drops slightly on rising. If the blood pressure drops, the pulse should be checked simultaneously; the pulse rate should increase as blood pressure drops. Failure of the pulse to rise suggests the problem is neurogenic (e.g., diabetic patients with peripheral neuropathy) or the patient is taking a beta-blocker. The presence of orthostatic hypotension suggests that the patient has lost 1 liter or more of vascular volume, and referral for medical care is necessary.]]></description>
		<link>http://laxativedrugs.com/index.php/diarrhea/assessment-of-diarrhea</link>
			</item>
	<item>
		<title>Complementary and Alternative Therapies</title>
		<description><![CDATA[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 diarrhea in children by an average of 0.7 days and reduce diarrhea frequency on day 2 of treatment by an average of 1.6 stools.Therapy with L. rhamnosus GG, L. addophilus, and .S. boulardii may also offer clinical benefit in antibiotic-associated diarrhea; a recent meta-analysis reported odds ratios favoring active treatment with these live organisms over placebo in preventing this condition. Probiotics appear to be safe; major side effects, such as Lactobadllus sepsis, have been reported only rarely. The role of probiotics in bacterial gastroenteritis and moderate-to-severe diarrhea is not supported conclusively by available evidence. The Food and Agriculture Organization of the United Nations and WHO have recognized the benefits of probiotics in the prevention and treatment of acute diarrhea. However, probiotics are not recognized as medications by FDA: their classification as dietary supplements or components of functional foods limits the health claims that can be made. Therefore, probiotics cannot be recommended to treat or prevent acute, uncomplicated diarrhea, but they can be recommended for maintenance of gastrointestinal tract function. Several large studies performed in developing countries have shown that daily zinc supplementation in young children with acute diarrhea reduces total stool output, frequency of watery stools, and duration and severity of diarrhea. These children who are at risk for diarrheal disease are zinc-deficient because of poor nutrition; in addition, diarrhea increases intestinal losses of zinc considerably, further compromising zinc status, even in those with normal plasma zinc concentrations. Zinc deficiency is associated with impaired cellular and humoral immunity, as well as adverse gastrointestinal effects such as impaired water and electrolyte absorption, increased secretion in response to bacterial endotoxin. and decreased brush border enzymes. WHO/UNICEF recommend that children with acute diarrhea also receive zinc (10 mg of elemental zinc/day for infants younger than 6 months: 20 mg of elemental zinc/day for older infants and children) for 10 to 14 days. The role of zinc supplementation in young children with diarrhea in developed countries is not yet defined. There is no evidence to substantiate the safety and effectiveness of herbal and homeopathic therapies in the treatment of acute diarrheal diseases; their use cannot be recommended.]]></description>
		<link>http://laxativedrugs.com/index.php/diarrhea/complementary-and-alternative-therapies</link>
			</item>
	<item>
		<title>Pharmacologic Therapy</title>
		<description><![CDATA[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 and Dextrose Concentrations of Household Fluids Clear Liquids Sodium (mEq/L) Potassium (mEq/L) Bicarbonate (mEq/L) Dextrose (g/L) Osmolarity (mOsm/L) Cola 2 0.1 13 50-150 dextrose and fructose 550 Ginger ale 3 1 4 50-150 dextrose and fructose 540 Apple juice 3 20 0 10-150 dextrose and fructose 700 Chicken broth 250 5 0 0 450 Tea 0 0 0 0 5 Gatorade 20 3 3 45 dextrose and other sugars 330 Seven Up 7.5 0.2 0 80 dextrose and fructose 564 Recommended Dosages of Antidiarrheal Agents for Acute Diarrhea Adult Dosages Medication Dosage Forms (Maximum Daily Dosage) Pediatric Dosages Duration of Use Loperamide Caplets (2 mg), liquid (1 mg/7.5 mL) 4 mg initially, then 2 mg after each loose stool (not to exceed 8 mg/day) Consult product instructions; not recommended for children &#60; 6 years except under medical supervision 48 hours Bismuth subsalicylate Tablets (262 mg), caplets (262 mg) liquids (262 mg/ 15 mL, 525 mg/ 15 mL) 525 mg every 30-60 minutes up to 4200 mg/day; (8 doses/day) Not recommended for children &#60; 12 years except under medical supervision 48 hours Digestive enzymes (lactase) Chewable tablets, caplets, liquids 5-15 drops placed in or taken with dairy product; 1-3 tablets or 1-2 capsules with first bite of dairy product Same as adult dosage Taken with each consumption of dairy product Formed stools can have high water content, and substantial water losses may continue despite the change in consistency. Moreover, reliance on drugs shifts the focus away from management of fluids and electrolytes and dietary measures, increasing the risk for potentially dangerous side effects, such as toxic megacolon. without offering additional benefits. Because intestinal viruses are the leading cause of self-limiting acute gastroenteritis, antibiotics are not routinely recommended. Loperamide Loperamide is a popular, effective, and safe nonprescription antidiarrheal agent. It is a synthetic opioid agonist that produces antidiarrheal effects by stimulating micro-opioid receptors located on the intestinal circular muscles. This action slows intestinal morality, allowing absorption of electrolytes and water through the intestine. Stimulation of gastrointestinal micro-opioid receptors also decreases gastrointestinal secretion, which may contribute to the drug&#8216;s antidiarrheal effects. Loperamide is approximately 50-fold more potent than morphine and two to three times more potent than diphenoxylate in its effects on gastrointestinal motility. However, loperamide penetrates the central nervous system (CNS) poorly and therefore has a lower risk for CNS side effects. Other pharmacologic mechanisms for loperamide&#8217;s antidiarrheal effects may include disruption of cholinergic and noncholinergic mechanisms involved in the regulation of peristalsis, inhibition of calmodulin function, and inhibition of voltage-dependent calcium channels. The effects on calmodulin and calcium channels may contribute to loperamide&#8217;s antisecretory effects. Loperamide is used to provide symptomatic relief for acute, nonspecific diarrhea. Its therapeutic effects include reduction of daily fecal volume, increased viscosity, bulk volume, and reduced fluid and electrolyte loss. It may be used when the patient is afebrile or has a low-grade fever and does not have bloody stools. Current product information provides directions for use in children as young as 2 years. However, its use in children younger than 6 years is not recommended, because it produces only modest, clinically insignificant effects on stool volume and duration of illness, with an unacceptably high risk of side effects (including life-threatening side effects such as ileus and toxic megacolon). Loperamide is also indicated as an antidiarrheal agent in travelers&#8217; diarrhea (in combination with antibiotics), for chronic diarrhea associated with irritable bowel syndrome and inflammatory bowel disease, and for reduction of the volume of discharge from high-output ileostomies. Off-label uses of loperamide include control of chronic diarrhea secondary to diabetic neuropathy and other conditions, as well as control of toddler diarrhea (defined as diarrhea of at least 1 month duration in an otherwise healthy, active, well-nourished child, and in whom stool examination has revealed no bacterial, viral, or protozoal pathogens). All of these uses require medical supervision. At usual doses, loperamide has few side effects other than occasional dizziness and constipation. Other infrequently occurring adverse effects include abdominal pain, abdominal distention. nausea, vomiting, dry mouth, fatigue, and hypersensitivity reactions. Loperamide is generally not recommended for use in patients with invasive (enteroinvasive E. coll, Salmonella, Sliigella, or C. jejuni) bacterial diarrhea or antibiotic-associated diarrhea (C. difficile), because it may (rarely) worsen diarrhea or cause toxic megacolon or paralytic ileus. However, there is no evidence that these complications occur in actual practice when loperamide is used with appropriate antimicrobial therapy. Patients with symptoms suggestive of infection with invasive organisms or antibiotic-associated diarrhea (i.e., fecal leukocytes, high fever, or blood or mucus in the stool) require evaluation by a primary care provider for proper management. If abdominal distention. constipation, or ileus occurs, loperamide should be discontinued. No significant drug-drug interactions are reported for loperamide. Bismuth Subsalicylate Bismuth subsalicylate is effective in the treatment of acute diarrhea, including travelers&#8217; diarrhea, significantly reducing the number of diarrhea] stools. Bismuth subsalicylate reacts with hydrochloric acid in the stomach to form bismuth oxychloride and salicylic acid. Bismuth oxychloride is insoluble and poorly absorbed from the gastrointestinal tract; less than 1% of the administered dose is absorbed systemically. The salicylate is readily and efficiently absorbed. Both moieties are pharmacologically active; each produces effects that reduce frequency of unformed stools, increase stool consistency, relieve abdominal cramping, and decrease nausea and vomiting in children and adults. In travelers&#8217; diarrhea, the bismuth moiety exerts direct antimicrobial effects against ETEC and EAEC, C, jejuni, and other diarrhea] pathogens, whereas the salicylate moiety exerts antisecretory effects that reduce fluid and electrolyte losses in acute diarrhea. The antisecretory effects may be mediated by-several mechanisms, including inhibition of prostaglandin synthesis, inhibition of intestinal secretion through stimulation of sodium and chloride reabsorption. or disruption of calcium-mediated processes that regulate intestinal ion transport. Bismuth subsalicylate also directly binds to enterotoxins produced by E. coli and other diarrheal pathogens; however, the clinical significance of this effect in the treatment of diarrhea is not clear. Bismuth subsalicylate is FDA-approved for management of acute diarrhea, including travelers&#8217; diarrhea, in adults and children [...]]]></description>
		<link>http://laxativedrugs.com/index.php/diarrhea/pharmacologic-therapy-3</link>
			</item>
	<item>
		<title>Treatment of Diarrhea</title>
		<description><![CDATA[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&#8217;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&#8217;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 &#60;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 &#60;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&#8217;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 [...]]]></description>
		<link>http://laxativedrugs.com/index.php/diarrhea/treatment-of-diarrhea</link>
			</item>
	<item>
		<title>Clinical Presentation of Diarrhea</title>
		<description><![CDATA[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 diarrheal illnesses. Table Clinical Classification of Diarrhea correlates the clinical groups and mechanism with their most common causes. Bacterial and viral enterotoxins play a role in the pathophysiology ol secretory diarrheas. Enterotoxins elaborated by E. coli and Vibrio cholera evoke the release of endogenous secretagogues that mediate secretory reflexes, including serotonin, substance P, and vasoactive intestinal peptide. Some enterotoxins, such as cholera toxin, can directly stimulate gastrointestinal secretomotor neurons to increase intestinal secretion. C. difficile enterotoxin A also injures enterocytes to evoke a necroinflammatory response that causes a secretory diarrhea. Rotaviruses produce an enterotoxin that causes a calcium-mediated secretory diarrhea. In addition, inflammatory mediators (e.g., interleukins 1 and 6. prostaglandins, substance P, tissue necrosis factor-alpha, and platelet-activating factor) evoked by enteric-infection stimulate a characteristic gastrointestinal motility pattern that leads to the urgent defecation associated with diarrhea. This altered motility also causes abdominal cramps. Stool characteristics give valuable information about the diarrhea&#8216;s pathophysiology. For example, undigested food particles in the stool suggest disease of the small intestine. Black, tarry stools may indicate upper gastrointestinal bleeding, and red stools suggest possible lower bowel or hemorrhoidal bleeding or simply recent ingestion of red food (e.g.. beets) or drug products (e.g., rifampin). Diarrhea originating from the small intestine is characterized by a marked outpouring of fluid high in potassium and bicarbonate. Passage of many small-volume stools suggests diarrhea with a colonic disorder. Yellowish stools may suggest the presence of bilirubin and a potentially serious pathology of the liver. A whitish tint to the stool suggests a fat malabsorption disease. Patients who have stool containing blood or mucus need medical evaluation. Fluid and electrolyte imbalance is the major complication of diarrheal illness. Therefore, assessment of the patient&#8217;s risk for dehydration and the degree of dehydration present is key in determining the appropriateness of self-care and the need for medical referral. The specific signs and symptoms of dehydration are associated with the severity of the diarrhea, as well as the etiology and degree of fluid and electrolyte losses (Table Assessment of Dehydration and Severity of Acute Diarrhea). Healthy patients with uncomplicated acute diarrhea usually improve clinically within 24 to 4.S hours. If the condition remains the same or worsens after 48 hours of onset, medical referral is necessary to prevent complications. Certain medical conditions cm increase the risk for dehydration. Referral for medical care should be considered for patients with diabetes mellitus severe cardiovascular or renal diseases, or multiple unstable chronic medical conditions. Specifically, medical evaluation is indicated for: Severe vomiting or dehydration. Passage of multiple small-volume stools containing blood and mucus. Fever of 38.5°C (101.3°F) or higher. Clinical Classification of Diarrhea Type Mechanism Common Causes Osmotic Unabsorbed solutes in intestines increase luminal osmotic load, retarding fluid absorption. Decreased fluid absorption of even a few hundred milliliters may cause diarrhea. Decreased absorption of solutes and fluid can be secondary to brush border damage caused by lactase deficiency or bacterial/viral infection. Viral-induced damage to epithelial cells accelerates migration of immature crypt cells to the tip of the villus; altered epithelial turnover also decreases absorption. Noroviruses, rotaviruses, E. coli, C.jejuni, lactase deficiency, magnesium antacid excess Secretory Stimulation of crypt cells produces net flow of electrolytes (most notably chloride) and fluids into intestinal lumen. Tumors can secrete gastrointestinal hormones and peptides that act as secretagogues. C. jejuni, C. difficile, E. coli, Salmonella, Shigella, Vibrio, rotaviruses, G. lamblia, Cryptosporidium sp. Isospora, ileal resection, thyroid cancer Inflammatory Impaired fluid absorption and leaking of mucus, blood, and pus into lumen caused by inflammation of intestinal mucosa (e.g., IBD) or bacterial infection (i.e., dysentery). C. jejuni, E. coli, Salmonella, Shigella, Yersinia, E. histolytica, ulcerative colitis, Crohn&#8217;s disease Motor Abnormally rapid intestinal transit time reduces contact time between luminal contents and absorptive areas of intestinal wall. irritable bowel syndrome, diabetic neuropathy Assessment of Dehydration and Severity of Acute Diarrhea Minimal or No Dehydration Self-Treatable Not Self-Treatable Mild-to-Moderate Dehydration/Diarrhea Severe Dehydration/Diarrhea Degree of dehydration (loss of body weight) &#60;3% 3%-9% &#62;9% Signs of dehydration Mental status Good, alert Normal, fatigued or restless, irritable Apathetic, lethargic, unconscious Thirst Drinks normally, might refuse liquids Thirsty, eager to drink Drinks poorly, unable to drink Heart rate Normal Normal to increased Tachycardia, bradycardia in most severe cases Quality of pulses Normal Normal to decreased Weak, thready, impalpable Breathing Normal Normal, fast Deep Eyes Normal Slightly sunken Deeply sunken Tears Present Decreased6 Absent Mouth and tongue Moist Dry Parched Skin fold Instant recoil Recoil in &#60;2 seconds Recoil in &#62;2 seconds Capillary refill Normal Prolonged Prolonged, minimal Extremities Warm Cool Cold, mottled, cyanotic Urine output Normal to decreased Decreased Minimal Number of unformed stools/day &#60;3 &#60;5 6-9 Other signs/symptoms Afebrile, normal blood pressure, no orthostatic changes in blood pressure/pulse May be afebrile or may develop fever &#62;102.2°F (39°C); normal blood pres- sure; mild orthostatic blood pressure/ pulse changes with or without mild orthostatic-related symptoms may be present; sunken fontanelle Fever &#62;102.2°F (39°C), low blood pressure, dizziness, severe abdominal pain Passage of six or more unformed stools in 24 hours or illness lasting 48 hours or longer. Diarrhea accompanied by severe abdominal pain in a patient older than 50 years. Patients with severe abdominal pain, particularly those older than 50 years, may have a complicating illness such as ischemic bowel disease. Immunocompromised patients, such as those receiving cancer treatment, organ transplant recipients, and patients with acquired immunodeficiency syndrome, also need medical evaluation, because their diarrhea will often be complicated and difficult to manage. Self-care medication may also be inappropriate for diarrhea during pregnancy, and pregnant women should consult with a primary care provider before self-treating. Children younger than 5 years and adults older than 65 years are at greater risk for complications than other age groups. In developed countries, most children experience complete recovery, although some die of complications. In the United States, approximately 300 to 450 children die annually from acute gastroenteritis; most of these deaths occur in infants. Children 2 years of age or younger are likely to suffer complications that require hospitalization. In [...]]]></description>
		<link>http://laxativedrugs.com/index.php/diarrhea/clinical-presentation-of-diarrhea</link>
			</item>
	<item>
		<title>Pathophysiology of Diarrhea</title>
		<description><![CDATA[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., nursing homes, prisons, and multifamily dwellings), consumption of unsafe foods (e.g., raw meat, eggs, and shellfish), and presence of medical conditions, such as acquired immunodeficiency syndrome, that predispose to infectious diarrhea. Acute diarrhea may also be caused by poisoning, medications, intolerance of certain foods, or various non-gastrointestinal (gastrointestinal) acute or chronic illnesses. Viral Gastroenteritis Norovinises are the most common viral pathogens, accounting for approximately 70% to 75% of viral gastroenteritis. The symptoms and clinical course are described in Table Common Infectious Diarrheas and Their Treatment. The virus is usually transmitted by contaminated water or food. Community-wide outbreaks may result when municipal water supplies become contaminated. Recent outbreaks of norovirus gastroenteritis on cruise ships have received attention, although 60% to 80% of all outbreaks occur on land.&#8221; Contaminated food is the most frequently identified vehicle of infection in this setting.&#8221; Person-to-person transmission may also be important, and it has been suggested that infected cruise ship crew members may serve as reservoirs of infection for passengers. Rotaviruses account for about 12% of all acute gastroenteritis and up to 50% of infantile gastroenteritis. The incidence of rotavirus infection is highest among children between 3 to 24 months of age. The peak infectious period is during the winter months (November to February). Spread is by the fecal-oral route. Clinical features are presented in Table Common Infectious Diarrheas and Their Treatment. Treatment is usually restricted to fluid and electrolyte therapy. Severe dehydration and electrolyte disturbances, however, can occur and may result in death. In 2006, a live, oral vaccine to prevent rotavirus gastroenteritis was licensed by the Food and Drug Administration (FDA) for routine use in healthy infants. In clinical trials, this vaccine prevented 74% of all rotavirus gastroenteritis cases and 98% of the severe cases, and reduced the need for hospitalization attributable to rotavirus gastroenteritis by 96%. Other, less frequent viral causes of gastroenteritis include adenoviruses, astroviruses, and hepatitis A virus. Bacterial Gastroenteritis Bacterial pathogens cause approximately 5 million episodes of acute gastroenteritis in the United States each year. Pathogens most commonly responsible for these cases, in order of decreasing incidence, are Cainpylobacicr sp.. Salmonella sp., Shigella sp., Eschcrichia coli (including 0157:H7, non-0157:H7 Shigatoxin-producing E. coli &#124;STEC), enterotoxigenic E. coli, and other diarrheagenic strains), Siapliylococcus sp., Clostridium sp., Yersinia ciucrocoliliai, and Bacillus cereus. Aeromonas sp. are being increasingly recognized as enteropathogens. particularly in food-borne disease; Bacteroidesfiagilis, Klebsiella oxytoca, and Laribacter honkongensis are newly identified causes of acute diarrhea.Cainpylobacicr is identified as the etiologic agent two to seven times more frequently than Salmonella, Shigella, or E. coli. Common Infectious Diarrheas and Their Treatment Type Epidemiologic/ Etiologic Factors Symptoms Treatment Usual Prognosis Viral Rotaviruses Infects infants; oral-fecal spread Onset of 24-48 hours; vomiting, fever, nausea, acute watery diarrhea Vigorous fluid and electrolyte replacement; no antibiotics Self-limiting; usually lasts 5-8 days Norovirus Infects all ages; frequently spread person to person by the fecal-oral route; causes &#8220;24-hour stomach flu&#8221; Onset of 24-48 hours; sudden-onset vomiting, nausea, headache, myalgia, fever, watery diarrhea Fluid and electrolytes; no antibiotics Self-limiting; usually lasts 12-60 hours Bacterial Campylobacter jejuni Ingestion of contaminated food or water; oral-fecal spread; immunocompromised host Onset of 24-72 hours; nausea, vomiting, headache, malaise, fever, watery diarrhea Fluid and electrolytes; in severe or persistent diarrhea, antibiotics may be required Self-limiting, usually &#60;7 days Salmonella Ingestion of improperly cooked or refrigerated poultry and dairy products; immunocompromised host Onset of 12-24 hours; diarrhea, fever, and chills Fluid and electrolytes for mild cases; antibiotics reserved for complicated cases Self-limiting Shigella Ingestion of contaminated vegetables or water; frequently spread person to person; immunocompro- mised host Onset of 24-48 hours; nausea, vomiting, diarrhea Fluid and electrolytes; antibiotics Self-limiting Escherichia coli Enterotoxigenic E. coli, Enteroaggregative E. coli Ingestion of contaminated food or water; recent travel outside the United States or to a U.S. border area Onset of 8-72 hours; watery diarrhea, fever, bdominal cramps, bloating, malaise, occasional vomiting Fluid and electrolytes; antibiotics Self-limiting, usually within 3-5 days Shigatoxin-producing E. coli (STEC) Ingestion of contami- nated food or water, direct person-to-person spread Onset of 8-72 hours; watery, often bloody, diarrhea, abdominal cramps, hemolytic uremic syndrome Fluid and electrolytes Self-limiting, usually within 5-10 days Clostridium difficile Antibiotic-associated diarrhea leading to pseudomembranous colitis Onset during or up to several weeks after antibiotic therapy; watery or mucoid diarrhea, high fever, cramping Fluid and electrolytes; discontinuation of offending agent; antibiotics (metronidazole, vancomycin) Self-limiting Closthdium perfringens Ingestion of contami- nated food, especially meat and poultry Onset of 8-14 hours; watery diarrhea with- out vomiting, cramping, midepigastric pain Fluid and electrolytes; no antibiotics Self-limiting, usually resolves within 24 hours Staphylococcus aureus Ingestion of improperly cooked or stored food Onset of 1-6 hours; nausea, vomiting, watery diarrhea Fluid and electrolytes; no antibiotics Self-limiting Yersinia enterocolitica Ingestion of contaminated food Onset within 16-48 hours; fever, abdominal pain, diarrhea, vomiting Fluid and electrolytes; antibiotics may be needed in severe cases Self-limiting, although diarrhea may persist for up to 3 weeks Vibrio cholera Ingestion of contaminated food, including undercooked or raw seafood; recent travel outside the United States Onset within 24-48 hours; painless, watery, often voluminous, diarrhea, vomiting Fluid and electrolytes; antibiotics needed in moderate-to-severe cases Self-limiting, although V. cholera may cause severe, fatal illness Bacillus cereus Ingestion of contami- nated food Onset within 10-12 hours; abdominal pain, watery diarrhea, tenesmus, nausea, vomiting Fluid and electrolytes; no antibiotics Self-limiting Protozoal Giardia lamblia Ingestion of water contaminated with human or animal feces; frequently spread person to person; immunocompro- mised host Onset of 1-3 weeks; acute or chronic watery diarrhea, nausea, vomiting, anorexia, flatulence, abdominal bloating. epigastric pain Fluids and electrolytes; antimicrobial therapy&#8221; Good, if treated Cryptosporidium sp. Frequently spread person to person; travel outside the United States; acquired immunodeficiency syndrome, immunocompromised host Onset of 2-14 days; acute or chronic watery diarrhea, abdominal pain, flatulence, malaise Fluid and electrolytes; antimicrobial therapy Self-limiting, lasting up to 3 weeks, except in patients with acquired immunodeficiency syndrome or other immunosup- pressive diseases Entamoeba histolytica Travel outside the United States; fecal soiled food or water. Immunocompromised host Chronic [...]]]></description>
		<link>http://laxativedrugs.com/index.php/diarrhea/pathophysiology-of-diarrhea</link>
			</item>
	<item>
		<title>Patient Counseling for Constipation</title>
		<description><![CDATA[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 should explain why a particular type of laxative is appropriate for the present situation, how to use the laxative, when to expect to see results, what adverse effects could occur, and what precautions to take. The box Patient Education for Constipation lists specific information to provide patients. Patient  education   for Constipation The objectives of self-treatment are to relieve constipation and restore &#8220;normal&#8221; bowel functioning by implementing (1) dietary and lifestyle measures and/or (2) the safe use of laxative products. For most patients, carefully following the product instructions and the self-care measures listed here will help ensure optimal therapeutic outcomes. Nondrug Measures Use nonpharmacological methods such as a high-fiber diet (goal is 25-35 grams per day), adequate fluid intake, and exercise to foster regular bowel movements. Increase dietary fiber by eating foods containing wheat grains, oats, fruits, and vegetables. Avoid constipating foods such as processed cheeses and concentrated sweets. Drink plenty of fluids (six to eight 8-ounce glasses a day) to aid in stool softening and to facilitate fecal evacuation. Develop and maintain a routine exercise program. Walking can be beneficial if your cardiovascular system is healthy and if you have no other apparent health risks. Establish a regular pattern for bathroom visits. Do not delay responding to the urge to defecate; allow adequate time for elimination in a relaxed, unhurried atmosphere. Maintain general emotional well-being and avoid stressful situations. Nonprescription Medications Do not routinely take laxatives if your bowel habits are interrupted for a day or two, or to routinely &#8220;clean your system.&#8221; Do not give laxatives to children younger than 6 years unless the use is recommended by a primary care provider. If you have kidney or liver disease, heart failure, hypertension, or other conditions requiring sodium, potassium, magnesium, or calcium restriction, do not use laxative products whose maximum daily dose contains more than 345 mg (15 mEq) of sodium, 975 mg (25 mEq) of potassium, 600 mg (50 mEq) of magnesium, or 1800 mg (90 mEq) of calcium. Consult your primary care provider before using laxatives if you currently have or have a history of any of the following conditions: colectomy, ileostomy, diabetes, heart disease, kidney disease, or swallowing difficulties. Consult a primary care provider or pharmacist before using a laxative product if you are taking anticoagulants (blood thinners), digoxin (a heart medicine), sodium polystyrene sulfonate (a treatment for high potassium levels), or tetracycline antibiotics. Avoid taking laxatives within 2 hours of taking other medications. Take most laxatives at bedtime, especially if more than 6-8 hours are required to produce results. Discard any medications that are outdated, that appear to have been tampered with, or that have an unusual appearance. Bulk-Forming Laxatives Unless a rapid effect, such as cleaning out the bowel for a diagnostic procedure or X-ray, is needed, take a bulk-forming laxative. Be sure to drink at least 8 ounces of fluid with each dose to prevent intestinal obstruction. Use bulk-forming agents with caution if you have diabetes or are on a carbohydrate-restricted diet. These agents have a high caloric content per dose and contain sugar. Do not give sugar-free bulk-forming products to patients with phenylketonuria. Such products may contain aspartame, which contributes excessive levels of phenylalanine, an amino acid these patients cannot metabolize. Lubricant Laxatives Do not give mineral oil to children younger than 6 years of age, pregnant patients, older patients, or patients taking anticoagulants. Do not take mineral oil with emollient laxatives. To avoid delaying the absorption of foods, nutrients, and vitamins, do not take mineral oil within 2 hours of eating. Saline Laxatives Take saline laxatives on an empty stomach; the presence of food will delay action. Do not take saline laxatives every day. Do not give these laxatives orally to children younger than 6 years of age or rectally to infants younger than 2 years of age. Hyperosmotic Laxatives Do not take the medication in larger than recommended amounts. When using PEG 3350 (MiraLAX), use the provided cap to measure the prescribed dose. Mix the powder with a full glass (8 ounces or 240 milliliters) of liquid such as water, juice, soda, coffee, or tea. Use of glycerin may be inappropriate in patients with a previous condition that caused rectal irritation. Stimulant Laxatives Do not use castor oil to treat constipation except under the advice of a primary care provider. A Do not take laxatives if you have any symptoms of appendicitis (i.e., abdominal pain, nausea, vomiting), rectal bleeding, painful anal or rectal conditions, bloating, or cramping. See a primary care provider immediately. A If symptoms of constipation are unrelieved by nondrug measures or by 1 week of any laxative treatment, see a primary care provider. Chronic constipation may be a symptom of an underlying medical condition. Evaluation of Patient Outcomes for Constipation Constipation often presents with a great degree of variability among individuals. Although a decrease in frequency of bowel movements is typically associated with constipation, difficulty in passing stools and a decrease in the amount passed are also common complaints. The type, severity, and chronicity of symptoms are important determinants in selecting the most appropriate treatment modality. Once therapy has been selected, effectiveness is determined by how rapidly constipation is relieved and to what degree normal bowel habits have been restored. For acute constipation, dietary changes and exercise or the use of bulk-forming laxatives may take several days to weeks to provide relief. Stimulant laxatives usually provide results within 24 hours: osmotic laxatives provide more immediate relief, usually within 15 minutes to 3 horn&#8217;s for oral preparations. Laxative enemas, often used when fecal impaction accompanies constipation, can produce evacuation within minutes. If initial treatment of constipation is ineffective, therapy should be repeated according to product-specific directions. If an adequate response is not achieved after a short period of laxative use, usually within 1 week, chronic constipation should be considered. Follow-up should be attempted to assess whether the patient should receive further evaluation by a primary care provider. Self-medication with laxatives can be safe and [...]]]></description>
		<link>http://laxativedrugs.com/index.php/constipation/patient-counseling-for-constipation</link>
			</item>
	<item>
		<title>Patient Factors</title>
		<description><![CDATA[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 the mechanism by which evacuation is produced. Tap water and normal saline create hulk through an osmotic volume effect; vegetable oils lubricate, soften, and facilitate the passage of hardened fecal matter: and the irritant action of soapsuds produces defecation. However, prolonged rectal irritation may occur after soap enemas and may result in proctitis or colitis. Therefore, soap enemas are not recommended. The popular sodium phosphate/sodium biphosphate enemas (e.g.. Fleet) fall into the category of saline laxatives. These agents are more efficient and effective than tap water, soapsuds, or saline enemas. Because they can alter fluid and electrolyte balance significantly with prolonged use, chronic use of these products is not warranted for controlling constipation. A properly administered enema cleans only the distal colon, most nearly approximating a normal bowel movement. Proper administration requires that the diagnosis, the enema fluid, and the technique of administration be correct. Improperly administered, an enema can produce fluid and electrolyte imbalances. Enema fluids have caused mucosal changes or spasm of the intestinal wall. Water intoxication has resulted from the use of tap water or soapsuds enemas in the presence of megacolon. A misdirected or inadequately lubricated nozzle may cause abrasion of the anal canal and rectal wall or may cause colonic perforation. Patients should be advised to follow all directions carefully when using these products. The patient should lie or be placed either on the left side with knees bent or in the knee-to-chest position. If the patient is in a sitting position, use of an enema clears only the rectum of fecal material. The solution should be allowed to flow into the rectum slowly; if the patient is uncomfortable, the flow is probably too fast. One pint (500 mL) or less of properly introduced fluid usually produces adequate evacuation if it is retained until definite lower abdominal cramping is felt. As long as 1 hour may be needed for the entire procedure. Bisacodyl-containing suppositories are promoted as replacements for enemas when the distal colon requires cleaning. Suppositories that contain bisacodyl are used for postoperative, antepartum, and postpartum care, and are adequate in preparing for proctosigmoidoscopy. Although bisacodyl suppositories are prescribed and are used more often than other suppositories, some clinicians still prefer enemas as agents for cleaning the lower bowel. Glycerin suppositories are useful in initiating the defecation reflex in children and in promoting rectal emptying in adults. Administration of Rectal Suppositories or Enemas Enemas 1. If someone else is administering the enema, lie on your left side with knees bent or in the knee-to-chest position. Position A is preferred for children older than 2 years. If self-administering the enema, lie on your back with your knees bent and buttocks raised. A pillow may be placed under the buttocks. 2.  If using a concentrated enema solution, dilute solution according to the product instructions. Prepare 1 pint (500 mL) for adults and 1/2 pint (250 mL) for children. 3.  Lubricate the enema tip with petroleum jelly or other non-medicated ointment/cream. Apply the lubricant to the anal area as well. 4.  Gently insert the enema tip 2 (recommended depth for children) to 3 inches into the rectum. 5.  Allow the solution to flow into the rectum slowly. If you experience discomfort, the flow is probably too fast. 6.  Retain the enema solution until definite lower abdominal cramping is felt. The parent/caregiver may have to gently hold a child&#8217;s buttocks closed to prevent the solution from being expelled too soon. Suppositories 1. Gently squeeze the suppository to determine if it is firm enough to insert. Chill a soft suppository by placing it in the refrigerator for a few minutes or by running it under cool running water. 2.  Remove the suppository from its wrapping. 3.  Dip the suppository for a few seconds in lukewarm water to soften the exterior. 4.  Lie on your left side with knees bent or in the knee-to-chest position. Position A is best for self-administration of a suppository. Small children can be held in a crawling position. 5.  Relax the buttock just before inserting the suppository to ease insertion. Gently insert the tapered end of the suppository high into the rectum. If the suppository slips out, it was not inserted past the anal sphincter (the muscle that keeps the rectum closed). 6.  Continue to lie down for a few minutes, and hold the buttocks together to allow the suppository to dissolve in the rectum. The parent/caregiver may have to gently hold a child&#8217;s buttocks closed. 7.  Remember that the medication is most effective when the bowel is empty. Try to avoid a bowel movement after insertion of the suppository for up to 1 hour so that the intended action can occur. Patient Preferences Liquid formulations of emollients may be made more palatable if mixed with juices or milk. The most commonly used products that contain castor oil are the more palatable emulsions. When plain castor oil is used, it may be administered with fruit juice or a carbonated beverage to mask its unpleasant taste. Chilling the oral form of a sodium phosphate-type product or taking it with ice seems to make it more palatable. Palatability may also be improved by drinking the product with a citrus fruit juice or with a citrus-flavored carbonated beverage. Alternative and Complementary Therapies Patients frequently treat constipation with a botanical product. Common dietary supplements include buckthorn, flaxseed, plantago, and senna. Although many of the commercially available stimulant and bulk-forming laxatives are derived from plants, some consumers prefer to use a &#8220;more natural&#8221; version of these products. In recent years. FDA has banned the use of aloe and cascara in nonprescription stimulant laxatives. Both agents are classified as generally unsafe and not effective. However, they are commonly found in many herbal teas, extracts, and pills. Individuals should either limit or avoid use of these products. They should also be cautioned against the use of botanical laxatives during pregnancy or breast-feeding, and in children. Consumers are increasingly selecting dietary supplements that contain probiotics to promote regularity [...]]]></description>
		<link>http://laxativedrugs.com/index.php/constipation/patient-factors</link>
			</item>
	<item>
		<title>Special Populations</title>
		<description><![CDATA[Children A number of factors can alter a child&#8217;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&#8217;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.&#8221; 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 Powder Methylcellulose 2 g/tsp Citrucel Sugar Free Powder Methylcellulose 2 g/tsp FiberCon Tablets Calcium polycarbophil 625 mg Maltsupex Liquid Barley malt extract 750 mg/tsp Metamucil Fiber Wafer Psyllium hydrophilic mucilloid 3.4 g/2 wafers Metamucil Smooth Texture, Sugar Free Orange Flavor Powder/Individual Packets Psyllium hydrophilic mucilloid 3.4 g/tsp Emollient Laxatives Colace Liquid Docusate sodium 20 mg/5 mL Correctol Stool Softener Softgels Docusate sodium 100 mg Lubricant Laxatives Fleet Mineral Oil Enema Mineral oil 100% Kondremul Emulsion Mineral oil 55% Saline Laxatives Citroma Solution Magnesium citrate 1.745 g/oz Fleet Ready-to-Use Enema Monobasic sodium phosphate 19 g/133 mL; dibasic sodium phosphate 7 g/133 mL Fleet Ready-to-Use Enema for Children Monobasic sodium phosphate 9.5 g/59 mL; dibasic sodium phosphate 3.5 g/59 mL Phillips&#8217; Milk of Magnesia Suspension Magnesium hydroxide 400 mg/5 mL Hyperosmotic Laxatives Fleet Babylax Liquid Glycerin 2.3 g Fleet Glycerin Suppository (Adult/Child Size) Glycerin 5.6 g MiraLAX Polyethylene glycol 3350 17g Stimulant Laxatives Dulcolax Tablets Bisacodyl 5 mg Ex-Lax Regular Strength Chocolate Tablets Sennosides 15 mg Purge Liquid Castor oil 95% Senokot Tablets Standardized senna concentrate 8.6 mg sennosides X-Prep Liquid Senna concentrate 3.7 g/75 mL standardized extract of senna fruit Combination Laxatives Perdiem Granules Senna (cassia pod concentrate) 0.74 g/tsp; psyllium 3.25 g/tsp Senokot-S Tablets Senna concentrate 8.6 mg sennosides; docusate sodium 50 mg Bowel Evacuant Kits Evac-Q-Kwik System Liquid/Suppository/Tablets Tablets: bisacodyl 15 mg/3 tablets Suppository: bisacodyl 10 mg Liquid: magnesium citrate 25 mEq/30 mL Children typically describe constipation as a difficulty in passing stools. Straining to pass large or hard stools can be painful. The child may then avoid or withhold bowel movements, resulting in worsening symptoms and fear of toileting. Normal frequency of bowel movements varies with the age of a child, making it difficult to recognize abnormal bowel habits. Because stooling becomes less frequent with increasing age. what may be a normal stooling pattern may be misdiagnosed as constipation. Parents seek advice for children of all ages when stooling patterns differ from what the parent perceives to be normal. Laxatives are often administered to children in an attempt to facilitate the passage of stools and to reestablish a normal stooling pattern. As a result, indiscriminate use of laxatives may result if the child has a stooling pattern that is changing or when other constipating factors are present. Children should be encouraged to establish a regular pattern of bowel movements and to avoid withholding of stools when the urge to have a bowel movement occurs. The clinician should do a thorough assessment of possible causes for constipation, and always consider a child&#8217;s age and any previous laxative use when recommending laxative products. The route of administration and the taste of oral products may be especially significant in children. Laxative use can be avoided in older children by encouraging them to adhere to suggested dietary guidelines to improve stool regularity. If medications are indicated in children younger than 5 years, glycerin suppositories may initiate the defecation reflex with onset usually within 15 to 60 minutes. Barley malt extract (malt soup extract) is relatively safe for infants younger than 2 months. Breast-fed infants may receive 6 to 10 mL in 2 to 4 ounces of water or fruit juice twice daily. Bottle-fed infants may receive 7.5 to 32 mL in a day&#8217;s total formula, or 5 to 10 ml. every second feeding. Mineral oil is not recommended because of the risk of aspiration. Stimulant laxatives and phosphate enemas should be avoided. In children who have fecal impaction, disimpaction can usually be achieved by the use of oral medications, enemas, or a combination of both. For infants younger than 1 year, glycerin suppositories or an enema can be used. However, some experts suggest avoiding enemas in infants younger than I year; if an enema is necessary, it should be done under the direction of a primary care provider.&#8221; For children I year and older, bisacodyl, magnesium citrate, PEG electrolyte solutions (e.g., Colyte and Golytely) or PEG solutions without electrolytes (MiraLAX in an initial dose of 1-1.5 g/kg/day for 3 days) are oral medications that may be useful for fecal impaction. Enemas containing phosphate soda or saline can also achieve disimpaction, although the oral route is less invasive. Parents should be cautioned that enemas act fast but can be traumatic for children. Saline agents can lead to salt and water retention. Use in children younger than 2 years may lead to electrolyte abnormalities, such as hypocalcemia, tetany. hypematremia. dehydration, and hyperphosphatemia. Electrolyte levels in these patients require careful monitoring. When fecal impaction is not present, treatment of constipation in infants should consist of glycerin suppositories or oral juices containing light or dark com syrup (1-3 mL/kg/day divided into two feedings per day). In children older than I year. milk of magnesia or PEG 3350 without electrolytes can be given according to age-appropriate dosage recommendations.&#8221; In general, stimulants should be avoided, as should excessive use of enemas. Patients of Advanced Age Constipation is more common in adults as they advance in age. Older adults (e.g.. &#62;65 years old) frequently describe constipation as straining to move bowels and report fewer stools per week. The aging process is associated with physiologic changes that prolong the transit time through the colon, which decreases the perception of the urge to defecate. Constipation in older adults can be precipitated or aggravated by-conditions such as neuromuscular disorders, confusion, dementia, and depression. In addition, the older population tends to have multiple medical conditions and take multiple medications that may contribute to the development of constipation. Constipating medications commonly used by older adults include narcotic analgesics; sedatives; hypnotics; antidepressants; anti-cholinergics; some antacids and vitamins that contain calcium, aluminum, or iron; and calcium channel blockers. Laxative use increases with age.&#8221; Abuse of stimulant laxatives, in an attempt to regulate bowel activity, was thought to lead paradoxically to worsening symptoms of constipation. However, lack of evidence supporting this view suggests otherwise. Lifestyle factors that can contribute to or worsen constipation in older adults include failure to establish a schedule for bowel [...]]]></description>
		<link>http://laxativedrugs.com/index.php/constipation/special-populations</link>
			</item>
</channel>
</rss>

