Diarrhea

• acute >14 days (self-limiting)
• persistent 14 - 4 weeks
• chronic >4 weeks

• norovirus: 24 hour flu; duration 12-60 hours
• rotavirus: infection in toddlers and infants; duration 5-8 days; vaccine prevents 75% cases

• secretory/watery
• osmotic
• inflammatory
• altered intestinal motility

• stimulation of crypt cells
• produces influx of electrolytes and water into the lumen

can happen with bacterial and viral enterotoxins and laxatives

unabsorbed solutes in the intestine that inhibit fluid absorption

stops in fasted state

inflammation of intestinal mucosa --> dec absorption of fluid, leakage of blood and pus into lumen

premature emptying of intestinal tract b/c too rapid intestinal transit time

usually chronic

• diabetic neuropathy
• intestinal resection
• gastric bypass surgery
• IBS

rehydration

• for moderate - severe dehydration
• severe: IV fluids
• moderate: ORT
• 6 months - 5 years: 50-100 mL/kg over 3-4 hrs
• > 5 yo: 2-4 liters over 3-4 hrs

• for mild dehydration
• give about 10 mL/kg for each stool or emesis

• <10 kg: 60-120 mL
• >10 kg: 120-240 mL

• anti-motility agents (opiates or opioid derivatives)
• anti-secretory agents
• antibiotics
• adsorbents
• digestive enzymes
• intestinal microflora

peripherally acting anti-secretary agent

atropine added

peripherally and centrally acting anti-secretary agent

• dec freq of unformed stools
• inc stool consistency
• dec abdominal cramping
• direct antimicrobial effects

• tongue discoloration
• dark stools
• salicylate toxicity/Reye's syndrome

• adsorbent
• absorbs nutrients, drugs, toxins, digestive juices