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Oral hydration is the best way to treat fluid loss from diarrhea
If FEVER PLUS EITHER leukocyte -, lactoferrin -, or hemoccult + OR patients with acute dysentery
OR patients with moderate/severe traveler’s diarrhea
o Empiric Treatment: Quinolone (-floxacin). Persistent diarrhea: Flagyl
o Risk of empiric antibiotic therapy:
Increased risk of HUS in EHEC
In EHEC, HUS may be facilitated by antimotility agents or worsen
neurological symptoms
Prolongs shedding of salmonella
Contraindications: C. difficile colitis, EHEC, salmonella
o Other therapies:
DOC: loperamide (Imodium) — recommended esp. for immunocompromised
HIV patients who can’t tolerate — use Tincture of Opium
o Last resort in HIV associated diarrhea: Octreotide
Diphenoxylate (Lomotil) — not ideal bc of central opiod effects
Bismuth subsalicylate — effective, but contraindicated in immunocompromised
encephelopathy
Zn supplements —> decrease duration & need of antibiotics; taken in addition to
ORS
Scrombroid Poisoning
o Antihistamines + H2 blockers, bronchodilators; cathartics & gastric lavage
Management of Constipation
o Exercise, hydrate, increase fiber intake. Decrease caffeine & alcohol
o Pharmacologic management
Laxatives — promote a soft stool
Cathartics — results in a soft to watery stool with some cramping
Purgatives — harsh cathartic causing watery stool with abdominal cramping
Lecture 15
L16
L17
Lecture 18