Diarrhea is the frequent passage of liquid stools. It can be due to a variety of causes like infection, toxins, anxiety and drugs. Acute diarrhea is one of the major causes of death in infants specially in the developing countries. Death is due to dehydration

Hence the approaches in the treatment of diarrhea include:

• Replacement of fluid and electrolytes
• Treatment of the cause.
• Antidiarrheal agents.

Oral rehydration

Oral rehydration with sodium chloride, glucose and water is useful. In the ileum, glucose increases sodium absorption and water follows. Oral rehydration powders are available. They are to be mixed with water and given in small amounts every 15-20 minutes for mild to moderate cases. In severe degrees of dehydration, prompt intravenous rehydration is necessary.

Composition of oral rehydration salt/solution (ORS)

Na Cl– — 3.5 gm
, K Cl– — 1.5 gm
,Sodium citrate — 2.9 gm
,Glucose — 20 gm.

Treatment of the cause of diarrhea :

Acute diarrhea could often be due to viral, bacterial or protozoal infection. The pathogen should be identified whenever possible and treated accordingly

Antidiarrheal drugs

Antidiarrheal drugs provide symptomatic relief and include adsorbents and antimotility drugs.

Adsorbents include kaolin, pectin, chalk and activated charcoal. These adsorb intestinal toxins and microorganisms by coating them.

Antimotility Drugs

Codeine

Codeine an opium alkaloid, stimulates the opioid receptors on the gastrointestinal smooth muscles to reduce peristalsis. This delays passage of intestinal contents and facilitates absorption of water. Nausea and vomiting may occur.

Diphenoxylate

Diphenoxylate is an opioid related to pethidine. It is given with a small dose of atropine in order to discourage abuse. In therapeutic doses CNS effects are not prominent-hence no risk of abuse. It is used only in diarrhea. Nausea, drowsiness and abdominal pain may occur.

Loperamide

Loperamide is an opiate. It has selective action on GI tract with additional anti secretory action. CNS effects are negligible. It is less sedating, less addicting and is the most commonly used antimotility drug. Its low solubility in water discourages abuse by injection. Loperamide may cause nausea, vomiting and abdominal cramps.

Other Drugs

Lactobacillus acidophilus

Lactobacillus acidophilus and lactobacillus sporogenes are available as powders and tablets and are useful in some diarrhea. They promote the growth of saccharolytic flora and alter the gut pH so that the growth of pathogenic micro organisms is inhibited.

Antispasmodics

Atropine derivatives like propantheline and dicyclomine relax gastrointestinal smooth muscles and relieve abdominal colics.

Traveller’s diarrhea:

Infection is the most common cause of traveller’s diarrhea and should be treated with suitable antimicrobials. Oral rehydration salts and loperamide may also be used.