metabolic acidosis. Severe diarrhea can be life threatening in young, elderly, and
debilitated patients.
Diarrhea is a symptom of an underlying cause. Therefore, you must treat the
underlying cause while treating the diarrhea. Diarrhea can be treated with a
combination of medications and nonpharmacological measures such as clear
liquids and oral solutions—Gatorade, Pedialyte, or Ricolyte—and intravenous
electrolyte solutions.
For example, traveler’s diarrhea also known as Montezuma’s Revenge is an
acute condition usually caused by E. colithat last less than 2 days but it can
become severe. A patient experiencing traveler’s diarrhea may be given fluoro-
quinolone antibiotics and loperamide (Immodium) to slow peristalsis and decrease
the frequency of the stools. Fluoroquinolone treats the underlying cause of diar-
rhea and loperamide treats the diarrhea itself.
Anti-diarrhea medications decrease the hypermotility (increased peristalsis)
that stimulates frequent bowel movements. Antidiarrheals should not be used for
longer than 2 days and should not be used if a fever is present. Anti-diarrhea
medication is available in four classifications.
See antidiarrheals listed in the Appendix. Detailed tables show doses, recom-
mendations, expectations, side effects, contraindications, and more; available on
the book’s Web site (see URL in Appendix).Opiates
Opiates decrease intestinal motility thereby decreasing persistalsis. Constipation
is a common side effect. Examples are tincture of opium, paregoric (camphorated
opium tincture), and codeine. Opiates are frequently combined with other antidiar-
rheal agents and can cause central nervous system (CNS) depression when taken
with alcohol, sedatives, or tranquillizers. Duration of action is about 2 hours.Opiate-Related Agents
Opiate-related agents are drugs that are synthetic compounds similar to opiates.
These drugs include diphenoxylate (Lomotil) (50% atropine to discourage
abuse; amount of atropine is subtherapeutic) and loperamide. Both are synthetic
drugs that are chemically related to meperidine (Demerol). Loperamide causes
less CNS depression than diphenoxylate and can be purchased over-the-counter.
It protects against diarrhea longer than a similar dose of Lomotil, reduces fecal
volume, and decreases intestinal fluid and electrolyte losses. These drugs can
cause nausea, vomiting, drowsiness, and abdominal distention. Tachycardia, para-
lytic ileus, urinary retention, decreased secretions, and physical dependence can
occur with prolonged use.(^336) CHAPTER 18 Gastrointestinal System