{"id":5309,"date":"2011-07-14T20:25:22","date_gmt":"2011-07-14T20:25:22","guid":{"rendered":"http:\/\/crashtext.org\/misc\/5309.htm\/"},"modified":"2011-10-02T19:51:27","modified_gmt":"2011-10-02T19:51:27","slug":"diarrhea-and-food-poisoning","status":"publish","type":"post","link":"https:\/\/crashingpatient.com\/medical-surgical\/diarrhea-and-food-poisoning.htm\/","title":{"rendered":"Diarrhea and Food Poisoning"},"content":{"rendered":"

<\/span>Diarrhea<\/span><\/h2>\n

Dysentery-diarrhea c blood and pus<\/p>\n

Mechanisms of diarrhea<\/strong><\/p>\n

1.\u00a0\u00a0\u00a0\u00a0\u00a0 Increased fluid (secretory)<\/p>\n

2.\u00a0\u00a0\u00a0\u00a0 Decreased absorption<\/p>\n

3.\u00a0\u00a0\u00a0\u00a0 Increased transit<\/p>\n

 <\/p>\n

Functional-only during day<\/p>\n

Eosinophila-consider strongyloides<\/p>\n

 <\/p>\n

Secretory which is due to poor electrolyte absorption does not stop with fasting<\/p>\n

Osmotic will stop with fasting<\/p>\n

 <\/p>\n

Antispasmodics<\/strong><\/p>\n

Bentyl 20 mg PO QID or 20 mg IM (not IV) Q4-6<\/p>\n

Glycopyrrolate 1-2 mg PO Bid\/Tid or 0.2 mg IV\/IM Tid\/Qid<\/p>\n

 <\/p>\n

osmotic diarrhea can be assessed by a stool osmotic gap >50 between measured and calculated (Stool Osm=2(Na+K))<\/p>\n

WHO solution for oral hydration<\/h4>\n

3\/4 tsp salt<\/p>\n

1 tsp baking soda<\/p>\n

1 cup of orange juice<\/p>\n

4 tbl sugar<\/p>\n

4 cups of water<\/p>\n

(fluids must contain sugar)<\/p>\n

IV<\/h4>\n

D5 \u00bd NS c \u00bd-1 amp bicarb and 20 meq KCl<\/p>\n

 <\/p>\n

Use Pepto, but not if ASA<\/strong> allergic<\/p>\n

If cramps, try donnatol and 25 mg demorol<\/p>\n

Get fecal wbc-if postive, get cx (pt can call for results and then get abx)<\/p>\n

Cipro 500 BID x 5 days (if you use abx, then can give immodium as well)<\/p>\n

Treat c bulk laxatives (yes laxatives in diarrhea they will absorb moisture reducing sx) Metamucil 1 tbl QID or<\/p>\n

Then Kaopectate 1 tbl QID or Pepto 2 tbl q 30 minutes until no sx or 8 doses<\/p>\n

<\/span>Food Poisoning (Non-Sea Food)<\/span><\/h2>\n

<\/span>Invasive Enteritis<\/span><\/h3>\n

Campylobacter<\/h4>\n

most common bacterial<\/p>\n

incubation 1-7 days, 24-72 hours most common<\/p>\n

can progress to Guillane Barre<\/p>\n

Bleed 60-90% of the time.\u00a0 ABX (Erythro or Cipro)<\/p>\n

Salmonella<\/h4>\n

2nd most common bacterial food poisoning<\/p>\n

S. typhimurium<\/em> and S. enteriditis<\/em><\/p>\n

Sx 6-48 hours after ingestion<\/p>\n

Treat infants, elderly, compromised with cipro in adults, amp in kiddies<\/p>\n

think underlying disease if healthy patient gets this infection<\/p>\n

Shigella<\/h4>\n

requires very small inoculum.\u00a0 Large WBCs<\/p>\n

can have neuro symptoms, especially in kids<\/p>\n

CBC with L shift and incredible number of bands<\/p>\n

Can result in reiter’s, hus, pneumonitis<\/p>\n

Yersinia<\/h4>\n

terminal ileum, mimics appendicitis.\u00a0 Can last 2 weeks. No ABX<\/p>\n

Vibrio parahaemolyticus and vulnificus<\/h4>\n

invasive vibrio<\/p>\n

from seafood<\/p>\n

Treatment of V. vulnificus<\/em> consists of doxycycline, a third generation cephalosporin, and an aminoglycoside<\/p>\n

E. Coli O157:H7<\/h4>\n

small # WBCs, hemolytic-uremic syndrome and TTP<\/p>\n

Can be normal flora in healthy cattle<\/p>\n

Fever is often absent, looks more like a LGIB than gastroenteritis<\/p>\n

Syndrome of Toxemia, not bacteremia. Shiga Toxin<\/p>\n

Pathophys is platelet-thrombin clots in arteries leading to ischemia<\/p>\n

Normal stool culturing will not pick up, must ask for specifically<\/p>\n

Antibiotics are not helpful<\/p>\n

Contaminated food does not taste off<\/p>\n

\"\"<\/a><\/p>\n

. Healthcare providers should specifically request testing for Shiga toxin producing E. coli (STEC) in patients being evaluated for bloody diarrhea or hemolytic uremic syndrome (HUS). The medium of choice for isolation is sorbitol-MacConkey (SMAC) agar. . Immediately report all suspected and confirmed cases of STEC infection or HUS to the New York City Department of Health and Mental Hygiene (DOHMH). . Send suspect and culture confirmed STEC (including E. coli O157:H7) isolates to the Public Health Laboratory (PHL) for confirmation, serotyping, and pulsed-field gel electrophoresis (PFGE).<\/p>\n

 <\/p>\n

Aeromona Hydrophilia<\/h4>\n

can last up to 10 weeks.\u00a0 From brackish water (wells and springs) USE ABX<\/p>\n

<\/span>Toxin Induced<\/span><\/h3>\n

Staph Aureus<\/h4>\n

acts by toxin effect on CNS, not in GI<\/p>\n

heat stable toxin, usually onset of sx is 6 hrs post-ingestion<\/p>\n

vomiting c mild diarrhea<\/p>\n

Use antiemetics<\/p>\n

Clostridium Perfringens<\/h4>\n

most common<\/p>\n

caused by spore formation of bacteria in gi tract which then causes release of enterotoxin<\/p>\n

heat resistant spores, meat or poultry<\/p>\n

6-24 hrs post-ingestion<\/p>\n

vomiting is rare, severe watery diarrhea<\/p>\n

can rarely cause necrotizing enterocolitis (can be fatal)<\/p>\n

B. Cereus<\/h4>\n

Emetic form<\/p>\n