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Pharmacy Practice IV

Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.


Diarrhoea // Page 1 of 3

Diarrhoea
1. Defined as loose, increased amount of watery stools occurring more than three times in one
day (more than 300g in 24 hours)
2. Acute or chronic
3. Globally, seven children die of diarrhoea every minute, mainly due to poor quality drinking
water and malnutrition, which still affects the majority of the world population

Causes

1. Acute diarrhoea is mainly caused by:
a. Bacterial infection and viral infections. Important to wash your hands with soap and
water after using the toilet. When the micro-organisms irritate the mucous
membrane of the small or large intestine resulting in an abnormally large quantity of
water in the motions. The irritated gut becomes very active, contracting excessively
and irregularly (colic). This can be accompanied by nausea, vomiting, and cold
sweats. In some cases the motions may include some blood
b. Food poisoning. You cannot assess the quality of food or detect contamination by its
smell or the way it looks. Food which is 'off' might be obvious but contaminated food
usually looks and tastes fine. Certain bacteria (usually staphylococci) irritate the
digestive tract by producing toxins. These toxins affect the mucous membrane much
sooner, a few hours after consumption, compared with bacterial infection. For this
reason, people with inflammation or sores on their hands should not prepare food for
others
c. Drug usage. When taking antibiotics, many people suffer diarrhoea, which may
continue after the antibiotic course has finished. The diarrhoea occurs because the
antibiotic alters the intestinal bacterial environment. It is not an allergic reaction. In
rare cases it requires medical treatment

2. Chronic diarrhoea (more than three weeks) can be a symptom of many disorders:
a. Irritable bowel syndrome
b. Acute, recurrent or chronic intestinal infections
c. Chronic intestinal inflammation (ulcerative colitis and Crohn's disease)
d. Chronic pancreatitis, which produces fatty stools
e. Laxatives
f. Intolerance to lactose or gluten (wheat protein)
Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Diarrhoea // Page 2 of 3

g. Improper diet (consumption of too much alcohol, coffee or sweets)
h. Metabolic disorders such as diabetes and thyrotoxicosis

Symptoms
1. Frequent, watery motions
2. Loss of appetite
3. Nausea, vomiting
4. Stomach pains
5. Fever
6. Dehydration

Treatment
1. Diarrhoea can usually be treated safely at home. Normally goes away by itself within a
week. Treatment with antibiotics is therefore rarely needed, and may cause side effects,
such as chronic diarrhoea

2. Anti-diarrhoea medicines relieve symptoms of acute (severe) diarrhoea and can be useful to
reduce discomfort and social disruption, except where there is blood in stools or if patient
has high temperature
a. Imodium (loperamide)
b. Lomotil

3. Other medicines
a. Paracetamol or ibuprofen if you have a fever or headache.
b. Buscopan for stomach pain (spasm)
c. Smecta (dioctahedral smectite)
non-systemic gastrointestinal tract muco-protective agent which interacts with mucus
molecules, to strengthen the mucosal barrier
has a specific binding action for rotavirus, one of the main causes of diarrhoea in children
antidiarrhoeal properties involved two mechanisms: adsorption of toxin, bacteria and viruses
and reinforces the intestinal mucus barrier, a pharmacological effect that is likely to be related
to the clinically observed reduction in duration of acute diarrhoea
d. Ultracarbon (activated charcoal)
charcoal is for diarrhoea and poisoning due to foods, heavy metals and drugs
should not be taken simultaneously with other drugs
Pharmacy Practice IV


Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.
Diarrhoea // Page 3 of 3

4. Drink more fluids
a. Drink up to 4 litres a day, especially oral rehydration salts (ORS), added to drinking
water
b. Patient more likely to be dehydrated if also vomiting
c. A sufficient intake has been obtained when the urine becomes light yellow in colour
d. ORS do not help cure the diarrhoea, but are ideal to prevent or treat dehydration

5. Eat normally
a. As soon as your appetite returns
b. Avoid foods containing milk for a couple of days
c. If cannot eat, it will do no harm, but continue drinking

6. Maintain good standards of hygiene. Especially important if any member of family has
diarrhoea

7. Probiotics

Refer

1. Dehydrated (particularly risky in children, symptoms include passing little urine, a dry
mouth and tongue, unresponsiveness, glazed eyes, drowsiness, confusion)

2. Blood or pus (yellow mucus) in stools

3. Vomiting continues for more than a day cannot drink

4. Diarrhoea does not start to clear up after 3-4 days

5. While traveling abroad

6. Acute diarrhoea in very old people

7. Chronic

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