Symptomatic Therapies

Symptomatic therapies for diarrhea include antimotility agents, antisecretory agents, adsorbants (silicates), and bulk forming agents (Powell and Szauter, 1993). Antimotility drugs, such as loperamide (Imodium), can be used safely for symptomatic relief in most cases of acute diarrhea. Antimotility agents inhibit peristalsis of the small intestinal smooth muscle and stimulate water and electrolyte absorption. The number of diarrheal stools is reduced by 80% with these agents. The recommended dose of loperamide is 4 mg initially, then 2 mg after each loose stool, to a maximum of 16 mg per day. Diphenoxylate/atropine (Lomotil) should be avoided because of the central opiate effect, risk of overdosage, and

TABLE 49-1. Oral Rehydration Solution Formula for Home Use

--teaspoon salt 1 teaspoon baking soda 1 cup orange juice or two bananas 4 tablespoons sugar

Blend and add above to 750 cc of clean water Adapted from Guerrant and Bobak, 1991.

Provides 90 mmol sodium, 20 mmol potassium, 80 mmol chloride, 30 mmol bicarbonate, and 111 mmol glucose.

the anticholinergic effects of the atropine, including urinary retention, mucosal and cutaneous dryness, tachycardia, and hyperthermia. Although controversial, antimotility drugs should be avoided with symptoms of inflammatory diarrhea or dysentery (ie, fever, cramps, and blood and pus in stool). However, in many cases, antimotility drugs can be used safely when used with appropriate antibiotic therapy. The antisecretory properties of salicylate in bismuth subsalicylate (Pepto-Bismol) can decrease diarrheal stools by 50% and is effective in decreasing symptoms of vomiting due to enteric viral infections. Salicylate overdose and bismuth encephalopathy have occurred after excessive use of bismuth subsalicylate.

Bulk forming agents add bulk and form to stool by absorbing water. Agents such as psyllium (Metamucil), methylcellulose (Citrucel) and polycarbophil (FiberCon) are safe and not systemically absorbed, but are only minimally effective. Silicate clay suspensions (adsorbents), such as activated attapulgite, also absorb water and improve stool consistency but do not decrease fecal water content.

Constipation Prescription

Constipation Prescription

Did you ever think feeling angry and irritable could be a symptom of constipation? A horrible fullness and pressing sharp pains against the bladders can’t help but affect your mood. Sometimes you just want everyone to leave you alone and sleep to escape the pain. It is virtually impossible to be constipated and keep a sunny disposition. Follow the steps in this guide to alleviate constipation and lead a happier healthy life.

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