Beruflich Dokumente
Kultur Dokumente
Diarrhoea
Dr. Jatin Dhanani
Principles of Mx
Treatment of Dehydration
Maintenance of nutrition
Drug therapy
Rehydration
Intravenous
Oral
In 1 L of water
NaCl - 85mM = 5 gm
or 5D
KCl 13mM = 1 gm
NaHCO3- 48mM = 4 gm
(Na 133mM, K 13mM, Cl 98mM, HCO3 48mM)
Ringer Lactate: Na 130 mM, K 4 mM, Cl 109mM
Initial volume equal to 10% BW in 2-4 hrs
Oral rehydration
Mild (5-7%BW) to moderate (7.5-10%BW)
fluid loss
Bases of oral rehydration.
Intactness of Glucose-Na+ co-transporter
General principle
Should be iso-/hypotonic (200-310mOsm/L)
Glucose Molar ratio should be slight high(but
not >110mM)
K+ and bicarbonate/citrate should be enough
New ORS
Na 75 mM
K 20 mM
Na+ 90 mM
K + 20 mM
Cl- 80 mM
Citrate 10 mM
Glucose 110 mM
Total osmolarity
Cl 65 mM
Citrate 10 mM
Glucose 75 mM
Total osmolarity
245 mOsm/L
NaCl 2.6 gm
KCl -1.5 gm
Trisod. Citrate 2.9 gm
Glucose 13.5 gm
Zinc in pediatric
Reduce duration and severity of ac.
Diarrhoea
Continue Zn for 10-14 days prevent
diarrhoea for next 2-4 months
Zn ORS are available
Maintenance of Nutrition
Never fasting
Feeding during dirrhoea increase digestive
Drug Therapy
Specific antimicrobial agents
Probiotics
Drug for Inflammatory Bowel Diseases(IBD)
Nonspecific antidiarrhoeal drugs
Antimicrobial Agents
Routinely used irrational
Antimicrobials of no
value in
Irritable Bowel
Syndrome (IBS)
Coeliac disease
Tropical sprue
Pancreatic enz def.
Thyrotoxicosis
Viral inf. (rotavirus)
Some bacterial inf. (S.
enterobacterius, ETEC)
Antimicrobials useful
Travellers diarrhoea
EPEC
Shigella enteritis
Nontyphoid salmonella
Y. enterocolitica
Antimicrobials
regularly used in
Cholera
C. jejuni
C. defficile
Amoebiasis/giardiasis
Antisecretory drugs
5-ASA comp.
Bismuth Subsalicylate
Atropine
Octreotide
Racecadrotril
Racecadotril (thiorphan)
Enkephalinase inhibitor prevent
hypersecretion by blocking receptor
Use in ac. secretory diarrhoea
Others
Codeine
Diphenoxylate
Loperamide
Opioid analogue
Acts through and receptors
prevent propulsive movement, increase
absorption and decrease secretion: increase
resistance to luminal transit and allow more
time for absorption
Codeine
Primary action peripheral in intestine and colon
Not use widely
Noninfective diarrhoea
Mild travellers diarrhoea
Idiopathic diarrhoea in AIDS
Chronic diarrhoea of IBS
Very mild IBD with urgency interfering with daily
work
Drug for
Inflammatory Bowel Diseases
5-ASA compounds
5-ASA compounds
Corticosteroids
Sulfasalazine, mesalazine, olsalazine,
Immunosuressants
balsalazine
TNF inhibitors
M/A: 5-ASA have local antiinflammatory
action by inhibition of production of cytokine,
PAF, TNF, NFKB
Also inhibits COX and LOX
A/E:
b/c of sulfapyridine rashes, joint pain, fever,
hemolysis, blood dyscrasias
Others: headache, malaise, anemia, oligozoospermia,
infertility, folic acid def.
Corticosteroid
For moderately sever to very severe condition
For acute exacerbation of disease
Prednisolone (40-60mg/d) effect starts
within 3-7 days and remission in 2-3 week
Hydrocortisone and methyl prednisolone for
IV inj in very severe condi. with extraintestinal
symptoms
Hydrocortisone enema for proctitis
Steroid use for short term therapy only
If not controlled immunosupressants
Immunosupressant
Azathioprine(6-MP), methotrexate, cyclosporine
Use in steroid dependent, steroid resistant,
relatively severe cases
Adverse effect should be weighed to the efficacy
TNF inhibitor
Infliximab, adalimumab
Use in severe and refractory cases.
Thank You