Nosocomial Diarrhea
Nosocomial Diarrhea:
- Definition: Loosening stool more than 3 times in at least 1 day, occurring after admission ≥ 72 hours.
Management Strategies:
- For Faecal Impaction:
- Common in the elderly, patients with neurological diseases, or those immobilized.
- Rectal Impaction (Most common):
- Diagnosis: Perform PR (Per Rectal Examination).
- Treatment: Rectal enema (water/mineral oil) or digital removal if no response.
- High Impaction:
- Diagnosis: Abdominal plain film.
- Treatment: Water-soluble contrast enema via sigmoidoscope or PEG (Polyethylene Glycol) 2 L orally.
- Drug-Related Diarrhoea:
- Common culprits include sorbitol, mycophenolate, colchicine, ARV (protease inhibitor), metformin, 5-FU, Azathioprine.
- Some drugs cause enterocolitis (fever, nausea/vomiting, mucous bloody stool), notably Mycophenolate, Azathioprine, and 5-FU.
- Enteral Feeding Related Diarrhoea:
- Prevention strategies include using a lactose-free diet or fiber-containing formula, infusing continuously instead of bolus infusion. Concentration and site of feeding are not significant factors.
- Antibiotics Associated or C.difficile Associated Diarrhoea:
- Causes include directly increasing motility (Erythromycin and Clavulanate) or decreasing non-pathogenic flora, leading to decreased conjugated bile, increased pathogens, and decreased short-chain fatty acids.
- Treatment:
- If no C.diff/WBC in stool: Stop/change ABT, administer bile salt resin (Cholestyramine).
- If C.diff/WBC in stool: Treat C.diff (Metronidazole or Vancomycin).
- If not responding: Consult GI for endoscopy and biopsy.
- Intraabdominal Inflammation/Infection:
- Conditions include diverticulitis, UTI, bowel ischemia.
Note: The management of nosocomial diarrhea involves differentiating the cause and tailoring the treatment accordingly, from adjusting medications and dietary formulas to treating specific infections like C.difficile with targeted antibiotics.