Acute diarrhea: Difference between revisions
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==Definitions== | == Definitions == | ||
Diarrhea: 3 or more stools per day; assumes shape of container | Diarrhea: 3 or more stools per day; assumes shape of container | ||
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Invasive=Infectious | Invasive=Infectious | ||
==== | == Diagnosis == | ||
=== Emergent Causes === | |||
===Emergent Causes=== | |||
1) Appendicitis | 1) Appendicitis | ||
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6) Diverticultis | 6) Diverticultis | ||
===Questions=== | === Questions === | ||
Ingestions | Ingestions | ||
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Chemo | Chemo | ||
== Toxigenic v. Infectious == | |||
{| class="pbNotSortable" cellpadding="1" cellspacing="1" width="400" | |||
|- | |||
{| class="pbNotSortable" | |||
| '''Characteristic''' | | '''Characteristic''' | ||
| '''Toxic''' | | '''Toxic''' | ||
| | | <span style="font-weight: bold">Infectious/Invasive</span><br/> | ||
|- | |- | ||
| Incubation | | Incubation | ||
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|} | |} | ||
==W/U== | == W/U == | ||
Toxigenic: | Toxigenic:Nothing | ||
Invasive: | Invasive: | ||
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Stool Cx | Stool Cx | ||
-Additional Cx: | -Additional Cx: E.Coli 0157:H7 | ||
C. dif toxin | C. dif toxin | ||
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Send stool WBCs only if diagnosis is uncertain; Sensitivity: 60-85% (ie unclear if invasive or toxigenic) | Send stool WBCs only if diagnosis is uncertain; Sensitivity: 60-85% (ie unclear if invasive or toxigenic) | ||
==Treatment== | == Treatment == | ||
===Toxigenic=== | === Toxigenic === | ||
Rehydrate with fluids containing sugar, salt, fluids po, | Rehydrate with fluids containing sugar, salt, fluids po, IV NS | ||
Avoid high osmolality (gatorade!), caffeine, lactose-containing (lactase removed during infection) | Avoid high osmolality (gatorade!), caffeine, lactose-containing (lactase removed during infection) | ||
Eat! - | Eat! - BRAT diet (small amounts banana, rice, apple sauce, toast) - will speed up recovery | ||
Analgesia as needed | Analgesia as needed | ||
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Antimotility (avoid ''alone'' in invasive illness) | Antimotility (avoid ''alone'' in invasive illness) | ||
===Infectious=== | === Infectious === | ||
'''Above plus:''' | '''Above plus:''' | ||
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3-7d treatment | 3-7d treatment | ||
====Empiric Abx==== | ==== Empiric Abx ==== | ||
1) Toxic appearance | 1) Toxic appearance | ||
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5) Severe dehydration | 5) Severe dehydration | ||
===Loperimide Contraindications=== | === Loperimide Contraindications === | ||
1) Pediatric | 1) Pediatric | ||
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(always give with abx) | (always give with abx) | ||
===WHO Oral Rehydration=== | === WHO Oral Rehydration === | ||
1 cup orange juice | 1 cup orange juice | ||
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in 1 liter of H2O | in 1 liter of H2O | ||
===Other=== | === Other === | ||
*Octreotide can be used in AIDS-associated diarrhea unresponsive to loperimide | *Octreotide can be used in AIDS-associated diarrhea unresponsive to loperimide | ||
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*Consider Pepto-Bismol for traveler's diarrhea (contraindicated in HIV-->encephalopathy) | *Consider Pepto-Bismol for traveler's diarrhea (contraindicated in HIV-->encephalopathy) | ||
== Source == | |||
==Source == | |||
3/12/06 DONALDSON (adapted from Rosen); 09 Birnbaumer | 3/12/06 DONALDSON (adapted from Rosen); 09 Birnbaumer | ||
<br/>[[Category:GI]] | |||
[[Category:GI]] | |||
Revision as of 04:32, 12 March 2011
Definitions
Diarrhea: 3 or more stools per day; assumes shape of container
Hyperacute: 1-6 hours
Acute: less than 2 weeks in duration
Gastroenteritis: diarrhea with nausea and or vomiting
Dysentery: Diarrhea with blood/mucus/pus
Invasive=Infectious
Diagnosis
Emergent Causes
1) Appendicitis
2) Mesenteric ischemia
3) Ectopic
4) CO poisoning
5) SAH
6) Diverticultis
Questions
Ingestions
Abd pain
Blood/Consistency
Frequency/Quantity/Odor
Tenesmus (infxs - shigella)
HIV/Immunocomp/Sexual hx
Recent Abx (<30 dys), PPI
Recent travel
Timing: Chronic (>1mo) vs. acute (<2wk)
Chemo
Toxigenic v. Infectious
| Characteristic | Toxic | Infectious/Invasive |
| Incubation | 2-12h | 1-3d |
| Onset | abrupt | gradual |
| Duration | <10-24h | 1-7days |
| Fever | No | Yes |
| Abdominal Pain | Minimal | Yes, tenesmus |
| Systemic | No | Yes, myalgias, N/V |
| Physical findings | Nontoxic | Toxic |
| Abdominal Tenderness | No | Yes |
| Stool Blood, WBCs | No | Yes |
W/U
Toxigenic:Nothing
Invasive:
Stool Cx
-Additional Cx: E.Coli 0157:H7
C. dif toxin
Sool O&P
-only if suspect parasitic, recent travel, failed abx, chronic diarrhea, immunocompromised
Send stool WBCs only if diagnosis is uncertain; Sensitivity: 60-85% (ie unclear if invasive or toxigenic)
Treatment
Toxigenic
Rehydrate with fluids containing sugar, salt, fluids po, IV NS
Avoid high osmolality (gatorade!), caffeine, lactose-containing (lactase removed during infection)
Eat! - BRAT diet (small amounts banana, rice, apple sauce, toast) - will speed up recovery
Analgesia as needed
Anti-diarrheals
Kaolin-pectin agents
Bismuth
Antimotility (avoid alone in invasive illness)
Infectious
Above plus:
Ciprofloxacin 500mg po bid or
Levofloxacin 500mg po qd or
Bactrim DS 1tab po bid (+/-)
3-7d treatment
Empiric Abx
1) Toxic appearance
2) Vital abnl
3) Fever >39
4) Bloody diarrhea
5) Severe dehydration
Loperimide Contraindications
1) Pediatric
2) IBD
3) C. Diff
4) Dysentery
(always give with abx)
WHO Oral Rehydration
1 cup orange juice
4 tsp sugar
1tsp baking powder
3/4 tsp salt
in 1 liter of H2O
Other
- Octreotide can be used in AIDS-associated diarrhea unresponsive to loperimide
- Consider Pepto-Bismol for traveler's diarrhea (contraindicated in HIV-->encephalopathy)
Source
3/12/06 DONALDSON (adapted from Rosen); 09 Birnbaumer