Diarrhea exclusions: 1) <6 month of age
2) Severe dehydration
a. Children showing behavioral changes
b. Children who have not urinated in 8 hours
c. Children who have no tears when crying
3) >= 6 month of age with persistent fever >102.2 F
4) Blood, mucus, or pus in stool
5) Protracted vomiting
6) Severe abdominal pain/distress
7) Risk for significant complications
a. DM, severe CVD, real disease
b. Multiple chronic medical condition
c. Immunosuppressed patients (cancer chemotherapy, organ transplant, AIDS)
8) Pregnancy
9) Chronic or persistent diarrhea
10) Inability of caregiver to administer ORS (Oral Rehydration therapy)
11) Suboptimal response to ORS already administered
Non pharmacological treatments:
1) Carbohydrates
2) Soft drinks
3) Plenty of fluids
Pharmacological treatments:
1) Pepto-Bismol/ bismuth subsalicylate
a. 2 tbsp Q ½ -1h PRN
b. 2 tab Q ½ -1h PRN
SIDE EFFECTS:
1) Discoloration of the tongue
2) Darkening of the stool
3) Constipation
Interactions:
1) There is an increased risk of side effects if taking this medication and a pain reliever/fever reducer together
Imodium: / loperamide
4mg followed by 2 mg after each loose stool
Side effects
2) Stomach pain
3) Nausea
4) Vomiting
5) Dizziness
6) Drowsiness
7) Dry mouth
Constipation:
Exclusion:
1) Abdominal pain
2) N&V
3) Sudden change in bowel habits that persist for 2 weeks
4) Use of laxative products >7 days unless directed by PCP
5) Occurrence of rectal bleeding or lack of bowel movement after laxative use at any time during treatment (patient should stop use and consult PCP)
6) Pregnant women referral
Non-pharmacological treatment:
1) Half of the grains should be whole grains
2) Increase INSOLUBLE fiber intake (will increase stool weight and bowel movement)
a. Soluble fibers: oats, barely, peas, apples
b. Insoluble: whole grains and different vegetables.
3) Limit food with little or no fiber (cheese)
4) Use fiber supplements
5) Fluid intake
a. Recommended 2L/day
b. Pregnant women: additional 300 mL/day
c. Women breast feeding: additional 750mL to 1L/day
6) Bowel training
a. Morning and 30 min after meals
Pharmacological treatments:
1) Bulk laxatives (increase insoluble fiber) Metamucil
2) Surfactants: softens the stool by adding fat and water Colace
3) Osmotic agent: restores lost water and electrolyte to digestive tract milk of magnesia, miralax
4) Stimulants empties the bowl by contracting the intestine: dulcolax, senokot
5) Colace/docusate sodium= stool softner
a. 1-3 cap QD
b. Adults and children >12 YOA
c. Effect within 12-72 hrs
Side effects:
Rash
Cramps
Nausea
Diarrhea
Stomach pain
Do not use more than 1 week
Do not take if taking mineral oil
6) Dulcolax/ Bisacodyl
a. 5-15 mg in tablet form
b. 10 mg in suppository form
c. Effect within 6-12 hours
Side effects
Stomach pain
Faintness
Cramps
Do not use for > 7 days
Do not exceed 30 mg/day
Milk within 1 hr of medication intake might cause gastric irritation
Do not take this medication within 1 hr of taking an antacid and H2 blocker
7) Miralax/ PEG 3350
a. Effect within 1-3 days
b. Sig: mix 1 capful w/ 8oz of water or juice.
Side effect
Nausea
Abdominal bloating
Cramping
Should not take more than recommended dosage
Do not use if you have bowel obstruction
Use with caution during pregnancy (this med is pregnancy category C)
Hyperglycemia: Symptoms:
Increased thirst
Increased urination
Blurry vision
Feeling tired
Slow healing of cuts or wounds
More frequent infections
Weight loss
Nausea and vomiting
Chronic complications of diabetes
Blindness
Kidney disease
Nerve damage (neuropathy)
Amputation
Heart attack
Stroke
TYPE I = ketoacidosis
Every 17 seconds, someone is diagnosed with diabetes
Diabetes is the leading cause of: new blindness among adults kidney failure non-traumatic lower-limb amputations
7th leading cause of death
Prediabetes: occur before type II diabetes
A1C should be <7
Itching creams: Temporary treatment of pain and itching
