Source: Powell PH and Fleming
VH. Diarrhea, Constipation, and Irritable Bowel Syndrome. In: DiPiro, JT,
Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy:
A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7978775.
Accessed May 15, 2012.
- Self-limited increase in frequency and decrease in consistency
of fecal discharge primarily due to viral, bacterial, or protozoal
- Most common bacterial causes: Shigella,
Salmonella, Campylobacter, Staphylococcus, and Escherichia coli
- Most common viral causes: Norwalk and rotavirus
- Medications (Table 1)
Table 1. Drugs Causing
Diarrhea |Favorite Table|Download (.pdf)
Table 1. Drugs Causing
Antacids containing magnesium
Auranofin (gold salt)
Any broad-spectrum antibiotic
Angiotensin-converting enzyme inhibitors
Nonsteroidal antiinflammatory drugs
Proton pump inhibitors
- Imbalance in absorption and secretion of water and electrolytes
- Change in active ion transport by decreased
sodium absorption or increased chloride secretion (secretory diarrhea)
- Change in intestinal motility caused by:
contact time in small intestine
- Premature emptying of colon
- Bacterial overgrowth
- Increase in luminal osmolarity
- Increase in tissue hydrostatic pressure
- Initiate isolation techniques in daycare centers and nursing
homes to prevent transmission of viral illness.
- Practice strict food handling, sanitation, water and other
environmental hygiene practices to prevent transmission of bacterial,
parasitic, and protozoal infections.
- Treat drinking water and limit consumption of fresh vegetables;
in addition, prophylactic antibiotics and bismuth subsalicylate
may be indicated when traveling.
- Acute diarrheal episodes subside within 72 hours of onset.
- Chronic diarrhea involves frequent attacks over extended periods
- Abrupt onset of:
- Abdominal pain
- Frequent, non-bloody bowel movements over 12–60 hours
- Pain described as gripping or aching localized to:
- Hypogastric region
- Left or right lower quadrant
- Sacral region
- Chronic diarrhea associated with:
- Weight loss
- Chronic weakness
- Physical exam demonstrates hyperperistalsis with borborygmi
and generalized or local tenderness.
- Stool analysis for microorganisms, blood, mucus, fat,
osmolality, pH, electrolyte and mineral concentration
- Stool cultures
- Stool test kits for detecting viruses, particularly rotavirus
- Radiographic studies helpful in neoplastic and inflammatory
- Assess for presence of colitis or cancer through direct
endoscopic visualization and biopsy of colon.
- Manage diet.
- Prevent excessive water, electrolyte, and acid-base disturbances.
- Provide symptomatic relief.
- Treat curable causes of diarrhea.
- Manage secondary disorders.
- Keep in mind that diarrhea may be defense mechanism that needs
to run its course.
- Manage dietary intake (Figs. 1 and 2)
solid foods for 24 hours.
- Avoid dairy products.
- Use digestible, low-residue diet for 24 hours when mild nausea
or vomiting also present.
- Take nothing by mouth if ...