DIARRHEA

DIARRHEA

It is a decreased consistency and increased frequency of fecal discharge as compared with an individual’s normal bowel pattern. Consistency and Frequency are variable within and between individuals.

Pathophysiology of diarrhea:

• A change in intestinal motility
•  A change in a  active ion transport by either increased chloride secretion or decreased sodium absorption
•  An increase in luminal osmolarity
• An increase in tissue hydrostatic pressure.

Signs and symptoms: Nausea, chills, abdominal pain, vomiting, headache, fever, and malaise, ineffective and painful stooling.

Diagnosis:

• Stool analysis includes examination for microorganisms in blood, mucus, fat, osmolality, pH, electrolyte and mineral concentration, and cultures.

Treatment: Antidiarrheal drugs include antimotility agents, adsorbents, and drugs that modify fluid and electrolyte transport.

1. Treatment of fluid depletion, shock and acidosis:

Rehydration therapy: It can be done orally or i.v.

Intravenous dehydration: it is needed only when fluid loss severly.The composition of Dhaka fluid is as follows.

NACL 5g            

KCL 1g

NAHCO₃ 4g

 Mix the above salts in 1 lit of water or 5% of glucose solution.

Oral rehydration: It is used when the fluid loss is mild or moderate.the composition of oral rehydration solution is as follows.

NACL 2.6g

KCL 1.5g

Tri sodium citrate 2.9g

Glucose 1.5 g

Water 1 lit

Maintenance of nutrition: Patients can eat banana, chicken soup, boiled potato, milk, sago, rice etc. Feeding during diarrhea increase the intestinal digestive enzymes and cell proliferation in mucosa.

Drug therapy:

Anti motility agents:- Codeine, loperamide, diphenoxylate

Adsorbents:- Methyl cellulose, psyllium, ispaghula, bismuth subsalicylate

Antisecretory drugs:- Atropine, misalazine,

Antimotility agents: Two drugs that are widely used to control diarrhea are loperamide and diphenoxylate. Both are analogs of meperidine and have Opioids-like actions on the gut, activating presynaptic Opioids receptors in the enteric nervous system to decrease peristalsis and inhibit acetylcholine release. At the usual doses, they lack analgesic effects.

Adverse effects: Drowsiness, abdominal cramps, and dizziness.

B. Adsorbents: Adsorbent agents, such as bismuth subsalicylate, methylcellulose, and aluminum hydroxide are used to control diarrhea. These agents act by adsorbing intestinal toxins or microorganisms and/or by coating or protecting the intestinal mucosa. They are much less effective than antimotility agents and it can interfere with the absorption of other drugs.

C. Antisecretory drugs: Bismuth subsalicylate, these agents modify fluid and electrolyte transport. used for traveler's diarrhea, decreases fluid secretion in the bowel. Its action may be due to its salicylate component as well as its coating action.

Diarrhea, rehydration, dehydration