DIARRHEA

Passage of abnormally frequent loose watery stools at least 3 stools or more in 1 day. Symptom of numerous conditions that bowel motility, cause secretion and retention of fluids in intestinal mucosa, and cause inflammation, irritation, and/or painful passage of stools resulting to DEHYDRATION and POOR ABSORPTION OF NUTRIENTS, FLUIDS, AND ELECTROLYTES.

Predisposing Factors 1. Intestinal Infection bacteria, virus, protozoa a. Contaminated food and fluids b. Inappropriate handling and storage of food and fluids c. Food Poisoning 2. Undigested, coarse, highly spicy foods irritant (produces and aggrevates diarrhea and flatulence) 3. Excessive intake of high fiber foods 4. Inadequate Chewing 5. Lack of digestive enzymes particularly pancreatic enzymes a. P. Trypsin digest protein b. P. Amylase digest carbs c. P. Lipase digest fats or lipids 6. Enzyme Lactase Deficiency causes lactose intolerance 7. Inflammatory Bowel Disorders a. AGE (Acute Gastroenteritis) c. Cholera rice, watery stools; painful b. Regional Enteritis d. Tumor 8. Drug Therapy a. Antibiotics b. Antacids (ex. Mg Hydroxide, Mg Trisilicate, Mg Carbonate or MOM) c. Excessive use of Laxatives 9. Stress 10. Hyperthyroidism increases bowel motility 11. Surgery excision (removal) of intestines 12. Travelers Diarrhea Types of Antidiarrheals 1. Local Acting Absorbant Agents

Absorbs excess water to cause a formed stool Absorbs bacteria and irritants Trade Name or Generic Name Activated Charcoal or Attapulgite a. Diatabs(improved; Loperamide) b. Guanamycin c. Polymagma d. Rheaban Kaolin / Pectin Mixture a. Kaopectate b. K-P / K-Peck c. Kao res P d. Apdiar e. Abemycin Characteristics

Absorbant; Chalk - like Absorbs H20, decreases fluidity of stool Binds enzymes, drugs, and toxins Administration: 2 tabs after each BM Absorbant, Chalk like (shake first) Has ASTRINGENT effect (causes contraction, absorbs water) Administration: 15 30 ml after each BM

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Systemic Agents a. Act thru Autonomic Nervous System b. Reduce Peristalsis and GIT Motility c. Allow mucosal lining to absorb nutrients, electrolytes, and fluids d. Leave a well formed stool from resides that was left in the colon. of Opium

Camphorated Tincture (Paregoric) a. Opium b. Tincture of Opium

0.4% of Morphine, Alcohol, Camphor, Anise Oil, and Benzoic Acid (alcohol and anise oil causes vasodilatation allowing morphine to enter and take effect. (Morphine is Analgesic) Pain in diarrhea or slows propulsive movements of S & L Intestines Short Duration of Admin. (1-2 days only) Administer 5 10 ml 1 4 x daily Produces EUPHORIA / ELATION & DEPENDENCE (habit forming) Morphine like activity Derivative of Meperidine Motility Has Atropine Sulfate that exhibits Anti-cholinergic effect. ( secretions; muscle contraction, increases HR, etc) Derivative of Meperidine HCL (Demerol) analgesic, narcotic to relieve pain Same as above Intestinal Motility doses causes morphine like effect (EUPHORIA) Contraindicated to: a. Pregnant and Lactating Mothers b. < 2 years old

Diphenoxylate w/ Atropine Sulfate a. Lomotil

Loperamide a. Imodium b. Lormide c. Lopdex d. Lopedium e. Alomide f. Diarrhemide

3.

Miscellaneous or Combination Agents

Lactobacillus Acidophilus a. Yakult b. Yoghurt c. Bacid d. Lactinex e. Lactovitalle Kaolin / Pectin Atropine Sulfate / Hyoscine / Alcohol Above Formulation plus Paregoric Donnagel Plain or Suspension

For the treatment of diarrhea associated with antibiotic therapy Used if there is disruption of normal bacteria in GIT Refrigerated and Shaken Properly In large doses may induce diarrhea has anticholinergic effect has anticholinergic effect absorbant anti- cholinergic systemic effect absorbant systemic effect

Donnagel PG Parefectolin

S/S of Patients with Diarrhea 1. 2. 3. 4. 5. 6. Droopy Eyes (not moist) Absence of tears Tongue Protruded Thirsty Lack of Strength Poor Skin Turgor (Dry)

S/S in Infants 1. 2. 3. 4. 5. Sunken Fontanel SEVERE: Inability to suck and eat Does not cry at times Poor Reflexes Thirsty

Oresol - used only for 24 hours then discard contents a. b. c. Sodium Chloride (3.5g) Sodium Citrate (2g) Sodium Bicarbonate (2.5g) d. e. Potassium Chloride (1.5g) Glucose (20g)

ORT Oral Rehydration Therapy; ORS Oral Rehydration Salts; ORSS Oral Rehydration Salt Solution Own Preparation of Oresol 1. 2. 3. 1 L (40mL) Preboiled H20 + 1 tsp Salt + 8 tsp Sugar OR 1 240 mL (glass) of H20 + Pinch of Salt + 1 tsp of Sugar If in Sachet, prepare preboiled h20. mix 1 sachet with water without any residue left then serve after each BM

Plan A to prevent dehydration; prophylactic Treatment 1. 2. 3. 4. 5. 6. Give child more fluids (preboil water, fluids that has astringent effect such as weak tea, apple juice, alm; if infant use a medicine dropper or small tsp) Give ORS substitute Give foods high in H20 content Give foods easy to digest (avoid high fiber foods) Give foods high in Potassium (Banana, Coconut) BRAT DIET (Banana, Rice, Apple, Tea) / BRA / BRACoke (give warm)

Plan B treatment with ORS; Get weight of client (Wt x 75 _____ = ml) Plan C treat severe dehydration quickly by the use of IV NGT (kung san ipapasok un ORS)