Talk:Diarrhea/Treatment

Treatment of diarrhea

(Moved from the diarrhea article)

Nurses encouraging this patient to drink an Oral Rehydration Solution to improve dehydration he acquired from cholera.
Courtesy:Centers for Disease Control and Prevention

1. Keep hydrated with properly balanced electrolytes. This is the most appropriate treatment in most cases of diarrhea, even dysentery. Large amounts of electrolytes are found in sports drinks, so it is a wise choice to drink these while ill with diarrhea. Sports drinks, however, are very high in sugar and an alternative (though less readily available and less tasty) is Pedialyte which is an electrolyte maintenance solution for infants with diarrhea. Consuming large amounts of water unbalanced by dietary electrolytes may result in a dangerous electrolytic imbalance which in rare cases can prove fatal (cf. water poisoning).
2. Try eating more often but smaller portions. Eat regularly. Don't eat or drink too quickly.
3. Intravenous fluids or a "drip": Sometimes, especially in children, dehydration can be life-threatening and intravenous fluid may be required.
4. Oral rehydration therapy: Taking a sugar/salt solution, which can be absorbed by the body.
5. Opioids and their analogs should not be used for infectious diarrhea as they are said to prolong the illness and may increase the risk of a carrier state. Opioids are the most effective antidiarrheals available. Their principal method of action is to inhibit peristalsis. Loperamide, also known as Imodium, is the most commonly used antidiarrheal. Loperamide is chemically related to the drug meperidine or Demerol, but does not cross the blood-brain barrier and does not appear to induce tolerance or dependence. Other opioids used to control diarrhea (in increasing order of strength) are: Lomotil (diphenoxylate with atropine); Motofen (difenoxin with atropine); codeine; paregoric (camphorated tincture of opium), opium tincture (laudanum); and morphine. The most potent opioids are generally reserved for chronic diarrhea (e.g., from complications of AIDS).
6. Antibiotics: antibiotics may be required if a bacterial cause is suspected and the patient is medically ill. They are sometimes also indicated for workers with carrier states in order to clear up an infection so that the person can resume work. Parasite-related diarrhea (e.g. giardiasis) require appropriate antibiotics. Antibiotics are not routinely used, as the cause is rarely bacterial and antibiotics may further upset intestinal flora and worsen rather than improve the diarrhea. Clostridium difficile-associated diarrhea and pseudomembranous colitis is often caused by antibiotic use. According to the Centers for Disease Control: most people with diarrhea caused by E.coli infections recover without antibiotics or other specific treatment within 5 to 10 days. Antibiotics should not be used to treat this [intestinal] infection. There is no evidence that antibiotics improve the course of disease, and it is thought that treatment with some antibiotics could lead to kidney complications. Antidiarrheal agents, such as loperamide (Imodium®), should also be avoided.
7. Dietary manipulation: in particular, patients with celiac disease should avoid wheat products. Patients with Irritable Bowel Syndrome can make dietary changes to prevent the over-reaction of their gastrocolic reflex that results in diarrhea. Having soluble fiber foods and supplements, substituting soy or rice products for dairy, being careful with fresh fruits and vegetables that are high in insoluble fiber, and eating regular small amounts can all help to lessen the symptoms of IBS. Foods and beverages to be avoided or minimized include red meat, oily or fatty (and fried) products, dairy (even when there is no lactose intolerance), solid chocolate, coffee (regular and decaffeinated), alcohol, carbonated beverages (especially those also containing sorbitol) and artificial sweeteners. Several of the most common dietary triggers are well-established by clinical studies at this point; research has shown that IBS patients are hypersensitive to fats, insoluble fibers, and fructose .
8. Calcium Carbonate has been shown to improve diarrhea at a dosage of approximately 1,000 mg. Importantly it must be calcium carbonate and not other forms of calcium. As long as you don't have irritable bowel syndrome this should help. The chewy, chocolate form made by Viactiv can be used. This is a link to a paper of how calcium carbonate reduces faecal water.[1]
9. Hygiene and isolation: Hygiene is important in limiting spread of the disease.
10. It is claimed that some fruit, such as bananas, mangoes, papaya, guava and pineapple, may have positive effects for this condition. Bananas have the merits of being easily obtainable, and they are unlikely to have any other significant unwanted side effects. Bananas and mangoes are high in soluble fiber, which can help regulate water content in the bowel and alleviate diarrhea. Mucilage, which can be obtained in capsule form, may be helpful for the same reason. Mucilage can also be used as cereal for babies, as it is easily digested. The high acid content of pineapple may make this food a bad choice for people suffering from chronic diarrhea.
11. A common non-pharmaceutical based treatment is to ingest only clear liquids for 24 hours (sports drinks, soup broth, popsicles, jello, ginger ale) followed by the slow introduction of a bland diet often described by the mnemonic BRAT for Bananas, Rice, Applesauce, and Toast.
12. In the Third World a common way to stop diarrhea is to take one handful of rice and an equal quantity of water, place in a pot, bring to a boil for 3 to 5 minutes. The fluid is then poured off and drunk. It is claimed that this remedy stops diarrhea faster than some over-the-counter remedies found in the First World. Water can be added to the remaining hard rice which is to be eaten - once cooked - by the patient.
13. A common remedy in Latin America, particularly Costa Rica, Panama and Nicaragua, is to mix a half glass of water with two spoons of prepared starch, a half spoon of sugar and the juice of a lemon and drink it; the starch is supposed to calm the intestines.
14. Phage therapy - bacteriophages were used for treating diarrhea by the Red Army until the breakup of the Soviet Union.Therapeutic phages were also produced in the United States. In the 1940s, the Eli Lilly Company (Indianapolis, Ind.) produced seven phage products for human use, including preparations targeted against staphylococci, streptococci, Escherichia coli, and other bacterial pathogens. Phages continued to be used therapeutically together with or instead of antibiotics in Eastern Europe and in the former Soviet Union. Several institutions in these countries were actively involved in therapeutic phage research and production, with activities centered at the Eliava Institute of Bacteriophage, Microbiology, and Virology (EIBMV) of the Georgian Academy of Sciences, Tbilisi, Georgia, and the Hirszfeld Institute of Immunology and Experimental Therapy (HIIET) of the Polish Academy of Sciences, Wroclaw, Poland.
15. Gastrointestinal absorbants may be used, including Activated carbon or charcoal, whose porosity allows them to remove excess water from the digestive tract.
16. Antispasmodics, including Scopolamine (Hyoscine) formulations, including Butylscopolamine, and Peppermint oil, may be beneficial in treating sympotmatic cramping in diarrhea.
17. Flavonoids, available in dark chocolate, have been shown to inhibit the development of fluids that result in diarrhea by targeting the intestinal cystic fibrosis transmembrane conductance regulator Cl– transport inhibiting cAMP-stimulated Cl– secretion in the intestine.