How to Treat Diarrhea

Etiology

There’s many possible causes for diarrhea.  Too much osmotically active particles in the GI tract, such as too many salt laxatives could be one reason.  Increased rate of intestinal secretions.  Alteration of the permeability of the intestinal lumen (such as Crohn’s disease).  Increased rate of peristalsis (could be drug induced such as by saline cathartics).  And of course, infection where there’s bacteria and toxins.

• Increase amount of osmotically active substance in GI lumen
• Increased rate of intestinal secretions
• Alteration of permeability of intestinal lumen
• Increased rate of peristalsis
• Infection

Drug Therapy

• Narcotic Derivatives
• Adsorbants
• Hydrophillic Colloids (we talked about this already)
• Restore Intestinal Flora: after having a bout of diarrhea
• Electrolyte Replacement: after having a bout of diarrhea

Narcotic Derivatives

Since narcotics decrease motility and normally cause constipation, they are useful for symptomatically treating diarrhea.  This would never be used however if we are dealing with an infection because it wouldn’t allow the bacteria to pass through.

• Contraindicated in infectious diarrhea

Adsorbants

An adsorbant is consumed orally, goes into the intestinal tract and binds up the bacteria and toxins in the intestinal tract.  It can also bind up medications and vitamins, so you don’t give those at the same time.

An example of an adsorbant is bismuth salt (peptobismol, kaopectate).  The full name is bismuth subsalicylate.  If a person has an allergy to aspirin or any salicylate, they can’t use this, but more importantly, you shouldn’t use this in children because of Reye’s syndrome.  Reye’s syndrome is associated with salicylates and viruses.  The diarrhea could be caused by a virus, so do not use this in children.

Can an adsorbant be used prophylactially?  Yes.  If you’re traveling somewhere that could cause diarrhea, you could take it daily to prevent, but you’re going to need a lot of peptobismol!

Recap

• Absorbs toxins and bacteria causing diarrhea
• Also absorbs medications and vitamins
• Administer at different time
• Useful to prevent infectious diarrhea especially when traveling
• Example: Bismuth Salt (Peptobismol, Kaopectate)

Restore Intestinal Flora

If an individual has had a bout of diarrhea, their normal flora in their intestinal tract is not normal anymore.  To replenish it, we want to give them lactobacillus acidophilus.  There’s a prescription grade of this and you’d only find it in the refrigerator.  And if you don’t have the prescription grade, there’s another way to do it, at least in the ambulatory setting, and that’s by eating yogurt.  Yogurt has this bacteria in it.  When someone is going to go on a broad spectrum antibiotic, there’s always a risk of super infection or yeast infection and we can give yogurt products.  We shouldn’t give it at the same time though.  We have to wait for the antibiotic to be completely absorbed and then consume the yogurt.

• Replaces natural flora bacteria in intestinal tract (lactobacillus acidophillus)
• Useful following broad spectrum antibiotic therapy
• Onset: 1 to 2 days
• Example: Lactobacillus Acidophillus (Bacid, Lactinex)
• Alternatives: dairy products

Electrolyte and Water Replacement

For most individuals, such as adults, this isn’t a problem, but babies/infants lose a lot of electrolytes and fluids and it needs to be replaced.  There’s a product called pedialyte and the manufacturer will flavor it anyway possible but it still tastes salty.  The colder it is however, the more palatable it is, which is why they’ve also made the popsicle version of it.  An adult could also get away with drinking gatorade but the problem with that is it has tons of sugar in it.

• Especially useful in children that have had diarrhea
• Replaces fluid and electrolytes
• Example: Pedialyte®