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Saturday, October 1, 2011


Composition of ORS:

The fluid lost in diarrhea is isotonic, so both water and electrolytes need to be replaced. Absorption of electrolytes from the gut is an active process (glucose coupled sodium transport: secondary active transport process) that requires energy. Infected mucosa is capable of very rapid fluid and electrolyte absorption if carbohydrate is available as an energy source. So this is why ORS is effective as it contains glucose as the energy source along with water and electrolytes.


ORS / ORT- Oral rehydration solution / Oral rehydration therapy: 

A very simple therapy in acute watery diarrhea. It is easily available and cheap but very effective, and can be administered even in the management of potentially lethal conditions like cholera.

The volume of fluid replacement required is estimated based on the following consideration:


Drug treatment of diarrhea:

Antidiarrhoeal drugs may be used safely in patients with mild to moderate acute diarrhea. However they should not be used in patients with bloody diarrhea, high fever, or systemic toxicity because of risk of worsening the underlying condition. They should also be stopped in patients whose diarrhea is getting worse despite therapy. 

Anitidiarrhoeal drugs are also used to treat chronic diarrhea caused by inflammatory bowel disease or inflammatory bowel syndrome.


Management of a case of diarrhea:

Patients with acute, potentially infective diarrhea should be isolated properly to minimize person to person transmission.

First therapy: Fluid replacement – Both water and electrolytes have to be replaced.

Second therapy: Treatment with drugs

 

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Note: In the making of the above article, following books were used:



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Clinical assessment of diarrhea:

The patient should be asked about:

1. The foods ingested
2. The duration and frequency of defecation

Chronic Diarrhea:
 
Most common cause is irritable bowel syndrome.

The usual symptoms of chronic diarrhea are:

1. Increased frequency of defecation
2. Loose, watery or pellet stools
3. Diarrhoea occurs rarely at night and is most sever before and after breakfast.

Acute Diarrhea:

Extremely common and a predominant sign of infective gastroenteritis.

Symptoms of acute diarrhea:



1. Urgency of defecation

2. Faecal incontinence


Diarrhea

Gastroenterologists define diarrhea as passage of more than 200g of stool daily. But this definition is usually applies for acute diarrhea. In chronic diarrhea the amount of stool passed may be less than 200 g.