Term
| Oral replacement therapy (ORT) |
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Definition
First line therapy
• Ideal solution (important in children)
• Osmolarity 210-250
• Sodium content: 50-60 mmol/L
• Poor ORT choices
• Coca-cola: 493 mOsm/L
• Apple juice: ~700 mOsm/L
• Zinc addition- developing countries |
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Term
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Definition
Goal: solid intake as soon as possible
• mild, low-fiber diet if N/V
• BRAT diet
• Banana, rice, applesauce, toast
• Poor evidence for recommendation
• Lactose Ingestion
• Reduce if lactose intolerant or utilize supplemental lactase enzymes |
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Term
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Definition
• Antimotility agents
• Adsorbents
• Antisecretory compounds
• Antibiotics
• Enzymes
• Probiotics |
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Term
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Definition
Loperamide (Imodium
Diphenoxylate/atropine (Lomotil)
Atropine; Difenoxin (Motofen)
Opium Tincture & Opiates |
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Term
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Definition
• MOA: interferes with peristalsis, may directly effect absorption/secretion
• Dosing (2mg cap or 1mg/5mL sol’n)
• 4mg initially, 2mg after each loose stool (MAX 16mg/day) |
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Term
| Diphenoxylate/atropine (Lomotil) |
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Definition
• MOA: inhibit GI motility and slow excess GI propulsion
• Dosing (2.5mg tab or 2.5mg/5mL sol’n)
• 2.5-5mg TID-QID (MAX 20mg/day)
• SE: blurred vision, dry mouth, urinary hesitancy |
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Term
| Atropine; Difenoxin (Motofen) |
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Definition
Similar to lomotil
• Dosing (1mg tablet)
• 2mg initial, 1mg after each loose stool (MAX 8mg/day) |
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Term
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Definition
| High abuse potential, not utilized |
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Term
| Bismuth subsalicylate (Pepto Bismol, Kaopectate) – OTC |
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Definition
• MOA: ant-secretory, anti-inflammatory, antibacterial effects
• Dosing:
• 262mg chew tab
• 262/5mL liquid or 524/15mL
• 2 tab or 30mL Q ½ -1hr (max 8 dose)
• Clinical Pearls
• Salicylism toxicity (tinnitus, N/V)
• DI: L tetracycline absorMon, interacts with anMcoagulants
• May notice darkening of tongue/stools |
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Term
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Definition
Bismuth subsalicylate (Pepto Bismol, Kaopectate) – OTC
Octreotide (Sandostatin®,
Sandostatin LAR Depot)– Rx |
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Term
Octreotide (Sandostatin®,
Sandostatin LAR Depot)– Rx |
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Definition
MOA
• blocks serotonin release
• direct inhibitory effects on
intestinal secretion
• Direct stimulatory effects on
intestinal absorption
• Use: severe refractory
diarrhea
• Carcinoid tumors
• dumping syndrome
• chemotherapy-induced diarrhea
• Dosing
• 100-600 mcg/day in 2 to 4
divided doses SQ daily (x2wks)
• Sandostatin LAR Depot: 20mg
IM Q4 weeks
• SE
• N/D/ Abdominal pain
• HA
• Decreased insulin release
• Local injection pain
• High doses: may reduce fat
absorption
• Prolonged use: Cholelithiasis |
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Term
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Definition
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Term
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Definition
Polycarbophil - OTC
• MOA: non-specific
• Absorbs 60x its weight in water
• Dosing: 500mg tablet
• 2 tab QID or after each loose
stool (max 12t/day)
• SE: may cause constipation,
abdominal pain
• Efficacy data: limited |
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Term
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Definition
Little evidence of efficacy
• Greatest impact on rotaviral diarrhea
• Less impact on invasive bacterial
• Dose >5 billion/dose
• Lactobacillus GC
• Saccharomyces boulardii
• Benefit?
• Reduction in symptoms
• ~1 day reduction
• May reduce risk of spreading infection
• Role in therapy: adjunctive management |
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Term
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Definition
• <3 months old
• Child with hx premature birth, chronic medical conditions,
concurrent illness
• Fever >39⁰C
• Visible blood in stool
• High-output
• Signs of dehydration
• Persistent diarrhea >48 hours without response to OTC
therapy |
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Term
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Definition
PO vaccines
• Prevents 74-78% rotavirus cases
• Decreased ER visits / hospitalization rates by 85%
• RotaTeq
• Pentavalent
• 3-dose regimen
• Rotarix
• Quadravalent
• 2-dose regimen |
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Term
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Definition
Prioxicam
Naproxen
Ketorlac |
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Term
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Definition
» Relieve symptoms
» Accelerate ulcer healing
» Reduce risk of ulcer recurrence
» Avoid ulcer‐related complications
» Removal of underlying cause and cure
˃ H. pylori eradication
˃ Discontinuation of NSAIDs
˃ Only way to prevent recurrence |
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Term
| Treatment of NSAID induced PUD |
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Definition
» Ideally, discontinue non‐selective NSAIDs or
consider dose reduction
» Therapeutic options to reduce complications w/
NSAIDS:
˃ Co‐therapy w/ PPI > H2RA
˃ Co‐therapy w/ misoprostol
˃ Change to selective COX‐2 inhibitor |
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Term
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Definition
High dose continuous infusion PPIs
– pantoprazole IV 80 mg bolus, then 8mg/hr infusion x 72 hours for
critical care patients
– pantoprazole 40 mg po BID thereafter |
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