Diarrhea

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1. IV therapy

    1. for adults:

        1. Serum 1/3 2/3 1-2 lit IV infusion

    2. for Children

        1. start with N/S 20cc/kg in 20 minutes repeat if needed *3

        2. Dehydration: w*(5-10-15)*10cc

        3. Maintenance (100-50-20cc/kg)

        4. if febrile >38C ⇒ 120cc/1 C

        5. Type of serum: HS + DW5%

            1. Serum DW5% ? cc + 30meq kcl + 112meq NaCl ⇒ 1/2 in 8 hours and 1/2 in 16 hours

        6. for each time defecation ⇒ 10cc/kg cc from HS + DW5%

        7. for each time vomiting ⇒ 4cc/kg cc from serum N/S 1 lit + 10meq/lit kcl

2. N/V

    1. Amp ondansetron 4mg IV (0.15mg/kg)

        1. or Amp plasil 10mg IV (0.1-0.2 mg/kg)

3. Abdominal pain

    1. Amp hyoscine #1 IM

        1. or Amp dicyclomine #1 IM

        2. or Tab dicyclomine 10 mg qid #20

        3. or Elixir dicyclomine 10mg qid #1

4. Inflammatory diarrhea ⇒ use Ab therapy

    1. >48 hrs

    2. bloody

    3. >40 C fever

    4. >50 y/o and severe abdominal pain

    5. tropical passenger

    6. >70 y/o

    7. immunodeficient

    8. severe watery diarrhea (vibrio)

    9. chef or hospital staff

5. Ab therapy

    1. Tab ciprofloxacin 500 mg #6 po bid

    2. for pregnancy and <18 y/o

        1. Tab azithromycin 500 mg #3 qd

    3. or

        1. Amp ceftriaxone 1 gr IV stat

        2. Amp Apotel 1gr IV stat

    4. for Giardia, Amebic

        1. Tab metronidazole 250 mg #20 tds

    5. if Hx of Ab therapy or suspicious of C. diff

        1. Tab metronidazole 500 mg tds #30

            1. or Vial vancomycin 1gr #10 PO

        2. Cap familact #60 BID

6. Non-inflammatory diarrhea

    1. Tab loperamide 2mg po #8, 2tab stat, 1tab/defecation, max 8 tabs

        1. or Tab diphenoxylate and atropine #8 q6h for 2 days

7. Pro-biotics in 2 hours post Ab therapy

    1. Cap familact #60 bid for adults

    2. Drop Pedilact 5 drops bid (1m/o-2y/o)

    3. Sachet Kidilact BID (mixed with food)

8. PO hydration

    1. Mild:

        1. Powder ORS 50cc/kg in 4 hours

    2. Moderate to severe

        1. Powder ORS 75cc/kg in 4 hours

    3. Handmade ORS: 4 tea spoon of sugar + 1/2 tea spoon of salt in 1 lit H2O

9. Fever + N/V + Inflammatory diarrhea

    1. Amp ondansetron 0.15mg/kg

    2. syrup acetaminophen 10-15mg/kg qid

        1. or amp acetaminophen 150 mg IV stat

    3. Syrup zinc sulfate 5mg/5ml 0.5mg/kg bid

    4. syrup azithromycin 120mg po start then 60 mg po qd for 4 days

10. Check

    1. S/E, S/C

    2. U/A, U/C

    3. CBC, diff

    4. B/C

    5. NA, K, BUN, Cr