{"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":"
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 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 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 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 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 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 terminal ileum, mimics appendicitis.\u00a0 Can last 2 weeks. No ABX<\/p>\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 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 can last up to 10 weeks.\u00a0 From brackish water (wells and springs) USE ABX<\/p>\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 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 Emetic form<\/p>\n Diarrheal Form<\/p>\n Dark flesh fish-tuna, mahi-mahi, blue fish, bonito<\/p>\n heat stable toxin, saurine, a histamine-like toxin.\u00a0 Histidine on the fish’s skin is converted to histamine by surface bacteria.<\/p>\n Can be prevented by proper refrigeration which keeps surface bacteria counts low.<\/p>\n metallic, peppery taste when eating the fish<\/p>\n resembles histamine intoxication-face flushing, urticaria, diarrhea, dry mouth, n\/v<\/p>\n Sx 30 minutes post-ingestion<\/p>\n Give Antihistamines (H1 and H2)<\/p>\n Diff Dx of Flushing:\u00a0 anaphylaxis, scombroid, ethanol\/disulfiram rxn, ethanol in Asians (low aldehyde dehyd.), Niacin<\/p>\n Half of all fish food poisoning (most common in USA)<\/p>\n Tropical Regions from 35N to 35S latitude<\/p>\n Neurotoxin made by plankton then consumed by fish<\/p>\n Most commonly implicated is the Barracuda, higher up on the food chain is highest concentration:\u00a0 sea bass, grouper<\/p>\n Colorless, odorless, tasteless<\/p>\n Not inactivated by cooking, freezing, drying or smoking<\/p>\n Blocks sodium membrane permeability????<\/p>\n 2 to 30 hour incubation, usually 5-6 hours<\/p>\n Begins c GI Sx: N\/V\/D<\/p>\n Progresses to neuromuscular\/sensory:\u00a0 myalgias, paresthesias (perioral and extremity), Burning of hands and feet, pruritis, Vertigo, CN abnormality<\/p>\n Sensory Reversal<\/em><\/strong>:\u00a0 Hot feels cold and vice versa<\/p>\n Sensation of looseness of teeth<\/p>\n Dysuria or dyspareunia if have sex with infected man<\/p>\n Worsened c consumption of nuts or alcohol<\/p>\n Can see bradycardia or hypotension from induced vagal tone<\/p>\n GI symptoms abate 24-48 hrs but other symptoms can last days-weeks<\/p>\n Mannitol 1 g\/kg over 30 min, though 1 recent study showed no benefit over NS (Neurology 58:873, March 2002) or antihistamines may have a role<\/p>\n Can also try amitriptyline 25 mg PO bid<\/p>\n <\/p>\n Ciguatera fish poisoning occurs when fish is eaten that contain toxins produced by a dinoflagellate microalgae called Gambierdiscus toxicus. The toxin accumulates in fish that feed on algae. These small fish are the major food source for larger fish, the toxin becoming more concentrated in the fatty tissue, flesh and viscera in the larger fish. The fish most commonly involved in poisonings include barracuda, red snapper, amberjack, grouper, surgeon fish, sea bass, parrot fish, hogfish, kingfish, sturgeon, and dolphin. In the U.S., poisonings occur most frequently in the warm waters of Hawaii, Florida, Puerto Rico, U.S. Virgin Islands and other tropical territories; however, some fish migrate as far as South Carolina and Texas where cases have been reported. Scientists theorize that with increasing water temperatures and changes in fish migration patterns, the presence of G. toxicus will possibly increase in the Gulf of Mexico and southern Atlantic coastline. Cases reported in Maryland are usually people returning from visits to endemic areas. Fish shipped from southern waters to other areas have also resulted in poisonings. The appearance, taste and smell of contaminated fish are not altered. The toxin is not diminished by cooking or freezing. In a series of 12,890 cases, the onset of clinical effects was within 24 hours in 96% of patients, within 12 hours in 77%, and within 6 hours in 52%. Paresthesias and myalgias of the mouth, tongue and extremities, as well as abdominal pain, nausea, vomiting, and profuse watery diarrhea are characteristic of ciguatera poisoning. Other effects may include muscle weakness, diaphoresis, pruritus, headache, watery eyes, blurred vision, metallic taste and chills. The sensation of burning when in contact with cold objects has been described. Bradycardia, hypotension, hypothermia and respiratory depression may develop in severe cases; however, ciguatera has a very low mortality rate (<0.5%). Gastrointestinal symptoms usually subside within 24-48 hours but neurologic and cardiovascular symptoms persist for days to weeks. Treatment consists of supportive care. Activated charcoal may be beneficial in the rare case when a patient presents very early after the ingestion, but most patients do not realize that they have eaten contaminated fish until symptoms develop. Patients should be counseled to avoid alcohol and exercising for several months as they may exacerbate the neurologic symptoms. (Lisa Booze MD Poisons)<\/p>\n (Fugu)<\/p>\n Fugu is the Japanese term for certain types of fish, such as puffer fish, balloon fish, and blowfish, whose flesh contains tetrodotoxin, the same potent paralytic neurotoxin found in blue ringed octopus saliva and certain newts.<\/p>\n Highest concentration is in ovaries>skin>liver>intestine.<\/p>\n Eating these fish will lead to at least some degree of poisoning.<\/p>\n Cooking does not destroy the toxin.<\/p>\n Toxins effects are caused by the blockage of sodium channels<\/p>\n After eating the fish there may be a delay of 30 minutes or so before onset of first symptoms, usually tingling around the lips. This may be followed by dysarthria, dysphagia, drooling and diplopia. Pupils may become fixed, dilated, which in tetrodotoxin poisoning, is not indicative of cerebral injury. Next limb weakness will occur, followed by respiratory paralysis, hypoxia, coma and death. Hypotension may occur in the later stages.<\/p>\n <\/p>\n First, insure the ABCs.\u00a0 The second priority is to remove remaining unabsorbed food from the stomach, to prevent further toxin reaching the circulation. If still within 1-3 hours after the fish meal, Lavage and then give AC<\/p>\n <\/p>\n Complete paralysis will require mechanical ventilation, but this is often short lived, being required only for a few hours, rarely a few days. Hypotension may respond to IV fluid loads, but pressors may be required in some cases.<\/p>\n <\/p>\n Probably the etiology of the Haitian zombie syndrome<\/p>\n Most common during red tide months (months without r in them) when dinoflagellates are most prevalent (shellfish fish feed on them)<\/p>\n Caused by dinoflagellate toxin saxitoxin<\/p>\n GI symptoms 30 min \u0096 5 hours post ingestion<\/p>\n Paresthesias of face and hands then weakness and paralysis<\/p>\n mussels and scallops<\/p>\n Brevitoxin, can be aerosolized by tides and cause respiratory distress in beach goers<\/p>\n Paresthesias, ataxia, and gi symptoms, neurological dysfunction, such as paresthesias, reversal of hot and cold sensations, ataxia, depression of cardiovascular and respiratory function, and such GI symptoms as nausea, vomiting, and diarrhea.<\/p>\n Domoic acid.\u00a0 Causes headaches, seizures, hemiparesis, memory loss, and altered mental status<\/p>\n Okadiac Acid and Dinophysis Toxin.\u00a0 Diarrhea, nausea, cramps, and vomiting<\/p>\n Onset ~3 hours, can last for days<\/p>\n symptoms consist of severe headache and paresthesia followed by paralysis. Palytoxin is a coronary vasoconstrictor. Ischemia is widespread, causing anoxia in major organs. Palytoxin may cause symptoms similar to ciguatera, as well as intense muscle contractions and rhabdomyolysis.<\/p>\n <\/p>\n ABX, especially clinda, pseudomembrane.\u00a0 If treating recurrence, give saccharomyces boulardi (yeast)<\/p>\n <\/p>\n from shellfish, give Pepto<\/p>\n Parasitic Enteritis<\/p>\n Intracellular protozoa.<\/p>\n Infection begins with the ingestion of oocysts from fecal\/oral contamination.\u00a0 7-10 day incubation, then diarrhea with low grade fever, nausea, and crampy abdominal pain.\u00a0 Rarely is there blood or leukocytes in the stool.\u00a0 Can also cause acalculous cholecystitis.\u00a0 Mainstay of treatment is supportive care.<\/p>\n from beaver crap.\u00a0 Also c travel to Russia (the Trotskys),<\/p>\n Giardia Lamblia is a single celled parasite that lives in intestines of animals and humans.<\/p>\n Infection begins with the ingestion of cysts from contaminated food or water or fecal\/oral contamination.<\/p>\n Diarrhea, sometimes with periods of constipation.\u00a0 Stool is frequently heme negative and can be without white cells as well.\u00a0 There are stool antigen studies, or stool can be examine for trophozoites.<\/p>\n Flagyl (remember disulfiram effects) 250 TID for 7 days.\u00a0 For pregnant women, use paromomycin or flagyl can be used in the second or third trimesters.<\/p>\n must get serologic testing before giving steroids.\u00a0 Flagyl<\/p>\n pinworm, tape test, make butt itch so babes put fingers in mouth.\u00a0 Vermoxx 2 doses 2 weeks apart<\/p>\n Need to quarantine for 3 days after last loose stools or get cx.<\/p>\n Travelers\u0092 diarrhea<\/p>\n <\/p>\n Pepto for prevention 2 tabs QID<\/p>\n Prophylaxis Cipro 500 mg QD<\/p>\n <\/p>\n Best treatment for food poisoning, tank them up with IV fluids<\/p>\n <\/p>\n |\u00a0\u00a0 \u00a0\u00a0 |\u00a0\u00a0 \u00a0\u00a0 |<\/p>\n","protected":false},"excerpt":{"rendered":" Array<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"_genesis_hide_title":false,"_genesis_hide_breadcrumbs":false,"_genesis_hide_singular_image":false,"_genesis_hide_footer_widgets":false,"_genesis_custom_body_class":"","_genesis_custom_post_class":"","_genesis_layout":"","footnotes":""},"categories":[8],"tags":[],"yoast_head":"\nWHO solution for oral hydration<\/h4>\n
IV<\/h4>\n
<\/span>Food Poisoning (Non-Sea Food)<\/span><\/h2>\n
<\/span>Invasive Enteritis<\/span><\/h3>\n
Campylobacter<\/h4>\n
Salmonella<\/h4>\n
Shigella<\/h4>\n
Yersinia<\/h4>\n
Vibrio parahaemolyticus and vulnificus<\/h4>\n
E. Coli O157:H7<\/h4>\n
Aeromona Hydrophilia<\/h4>\n
<\/span>Toxin Induced<\/span><\/h3>\n
Staph Aureus<\/h4>\n
Clostridium Perfringens<\/h4>\n
B. Cereus<\/h4>\n
\n
\n
Vibrio Cholera<\/h4>\n
<\/span>Sea Food Poisoning<\/span><\/h2>\n
<\/span>Scombroid<\/span><\/h3>\n
<\/span>Ciguatoxin (Ciguatera Syndrome)<\/span><\/h3>\n
<\/span>Tetrodotoxin poisoning<\/span><\/h3>\n
<\/span>Shellfish Poisoning<\/span><\/h3>\n
Paralytic<\/h4>\n
Neurotoxic<\/h4>\n
Amnestic<\/h4>\n
Diarrhetic<\/h4>\n
Palytoxin<\/strong><\/h4>\n
<\/span>C. Difficile<\/span><\/h2>\n
<\/span>Viral Gastroenteritis<\/span><\/h2>\n
Parvovirus (Norwalk)<\/h4>\n
Rotavirus (Winter)<\/h4>\n
<\/span>Cryptosporidium<\/span><\/h3>\n
<\/span>Giardiasis<\/span><\/h3>\n
Amebiasis<\/h4>\n
Enterobiasis<\/h4>\n
AIDS Diarrhea<\/a><\/h4>\n
<\/h2>\n
<\/h2>\n
<\/span>Travelers’ Diarrhea<\/span><\/h2>\n
E. Coli<\/h4>\n