diarrhoea

Pharmacy Practice IV

Prepared by Ibrahim Abdullah, BPharm (Hons) Nottingham, UK.

Diarrhoea // of 3

Diarrhoea

1. Defined as loose, increased amount of watery stools occurring more than three times in one

day (more than 300g in 24 hours)

2. Acute or chronic

3. Globally, seven children die of diarrhoea every minute, mainly due to poor quality drinking

water and malnutrition, which still affects the majority of the world population

Causes

1. Acute diarrhoea is mainly caused by:

a. Bacterial infection and viral infections. Important to wash your hands with soap and

water after using the toilet. When the micro-organisms irritate the mucous

membrane of the small or large intestine resulting in an abnormally large quantity of

water in the motions. The irritated gut becomes very active, contracting excessively

and irregularly (colic). This can be accompanied by nausea, vomiting, and cold

sweats. In some cases the motions may include some blood

b. Food poisoning. You cannot assess the quality of food or detect contamination by its

smell or the way it looks. Food which is 'off' might be obvious but contaminated food

usually looks and tastes fine. Certain bacteria (usually staphylococci) irritate the

digestive tract by producing toxins. These toxins affect the mucous membrane much

sooner, a few hours after consumption, compared with bacterial infection. For this

reason, people with inflammation or sores on their hands should not prepare food for

others

c. Drug usage. When taking antibiotics, many people suffer diarrhoea, which may

continue after the antibiotic course has finished. The diarrhoea occurs because the

antibiotic alters the intestinal bacterial environment. It is not an allergic reaction. In

rare cases it requires medical treatment

2. Chronic diarrhoea (more than three weeks) can be a symptom of many disorders:

a. Irritable bowel syndrome

b. Acute, recurrent or chronic intestinal infections

c. Chronic intestinal inflammation (ulcerative colitis and Crohn's disease)

d. Chronic pancreatitis, which produces fatty stools

e. Laxatives

f. Intolerance to lactose or gluten (wheat protein)



Diarrhoea // of 3

g. Improper diet (consumption of too much alcohol, coffee or sweets)

h. Metabolic disorders such as diabetes and thyrotoxicosis

Symptoms

1. Frequent, watery motions

2. Loss of appetite

3. Nausea, vomiting

4. Stomach pains

5. Fever

6. Dehydration

Treatment

1. Diarrhoea can usually be treated safely at home. Normally goes away by itself within a

week. Treatment with antibiotics is therefore rarely needed, and may cause side effects,

such as chronic diarrhoea

2. Anti-diarrhoea medicines relieve symptoms of acute (severe) diarrhoea and can be useful to

reduce discomfort and social disruption, except where there is blood in stools or if patient

has high temperature

a. Imodium (loperamide)

b. Lomotil

3. Other medicines

a. Paracetamol or ibuprofen if you have a fever or headache.

b. Buscopan for stomach pain (spasm)

c. Smecta (dioctahedral smectite)

� non-systemic gastrointestinal tract muco-protective agent which interacts with mucus

molecules, to strengthen the mucosal barrier

� has a specific binding action for rotavirus, one of the main causes of diarrhoea in children

� antidiarrhoeal properties involved two mechanisms: adsorption of toxin, bacteria and viruses

and reinforces the intestinal mucus barrier, a pharmacological effect that is likely to be related

to the clinically observed reduction in duration of acute diarrhoea

d. Ultracarbon (activated charcoal)

� charcoal is for diarrhoea and poisoning due to foods, heavy metals and drugs

� should not be taken simultaneously with other drugs



Diarrhoea // of 3

4. Drink more fluids

a. Drink up to 4 litres a day, especially oral rehydration salts (ORS), added to drinking

water

b. Patient more likely to be dehydrated if also vomiting

c. A sufficient intake has been obtained when the urine becomes light yellow in colour

d. ORS do not help cure the diarrhoea, but are ideal to prevent or treat dehydration

5. Eat normally

a. As soon as your appetite returns

b. Avoid foods containing milk for a couple of days

c. If cannot eat, it will do no harm, but continue drinking

6. Maintain good standards of hygiene. Especially important if any member of family has

diarrhoea

7. Probiotics

Refer

1. Dehydrated (particularly risky in children, symptoms include passing little urine, a dry

mouth and tongue, unresponsiveness, glazed eyes, drowsiness, confusion)

2. Blood or pus (yellow mucus) in stools

3. Vomiting continues for more than a day – cannot drink

4. Diarrhoea does not start to clear up after 3-4 days

5. While traveling abroad

6. Acute diarrhoea in very old people

7. Chronic

This article is for educational purpose only. The writer welcomes any feedback, which may be sent to

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diarrhoea

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