Therapy of Diarrhoea

• Absorption of ions:
• Cl-, HCO3- absorption is passive 
• HCO3- is also exchanged for Cl-
• Bicarbonate (accompanied by Na+) absorbed secretion of H+.
• K+ excreted by exchanging with Na+, also excreted by secretion to mucus.
• 
  
• Secretary process stimulated by PGs and intracellular Ca2+
• All acute enteric infections produce secretary diarrhoea. 
• Accumulation of cGMP caused by the heat stable toxin of Clostridium difficale and E. Histolytica
• enhances anion secretion.
• Carcinoid diarrhoea mediated by cAMP
• Bile acids case diarrhoea by activating adenylyl cyclase. 
• Hyper motility of bowel now considered to be ofsecondary role in diarrhoea.

Rational Of ORS

For more than 25 years, WHO and UNICEF recommended a single formulation of glucose-based

Oral Rehydration Salts (ORS) to prevent or treat dehydration from diarrhoea irrespective of the cause or age group affected.

Standard formula recommended was:

Nacl      60 mM (3.5 gm)

KCl      20 mM (1.5 gm)

Trisodium citrate    30 mM (2.9 gm)

Glucose     110mM (20 gm)

to be dissolved in   1 litre of water

Drug therapy

Antimicrobials:

Antimicrobials have limited role in overall treatment of diarrhoeal patients. 

Antimicrobials are of no value in diarrhoea due to non infective cases such as:

1.IBS

2. Coeliac disease 

3. Pancreatic enzyme deficiency

4. Topical sprue

5. Thyrotoxicosis. 

Antimicrobials regularly useful in:

1. Cholera: 

Tetracyclines (Doxycycline), Cotrimoxazole,

erythromycin.

2. Campylobacter jejuni

Norfloxacin, fluorquinolones. Erythromycin

3. Clostridium difficale associated pseudomembranous colitis: 

Metronidazole.

4. Amoebiasis and giardiasis

Anticholinergic agents:

Can reduce bowel motility and secretion, have poor

effect in secretary diarrhoeas.

Octreotide:

Somatostatin analogue, potent antisecretory and antimotility action on gut. 

These are opioid drugs which:

• Reduce propulsive movements
• Diminish intestinal secretions
• Enhances absorption 

MOA: Mediated via µ receptors (enteric neuronal network)

Codeine:

Anti-diarrhoeal effect attributed to its action on small

intestine and colon. 

Paracetamol (Acetaminophen) Mechanism of Action

Nepal Vs India U16 SAAF Live Result

Nepal U-16 Rishi Magar 20'

1 0 Match in Progress SAFF U-16 Championship 08-Aug-2011 03:30 PM NST Dasrath Stadium

India U-16

	28 '	India's two strikers; Laldanta Sanga and Daniel are looking for counter moves. Biswas, Sanjaya,Bibesk and Sagar Lama - Nepalese defenders are playing well.
	26 '	Nepalese boys are now marking the Indian defenders well, Supporters are behind them.
	25 '	What is this? should have been Red Card! Suman Lama is fouled. Yellow card is given. Free kick to Nepal. Nepal skipper, Heman Gurung steps in to take the shot, wow... going..going..going! MAN! inches above the bar!
	22 '	Nepalese supporters are still dancing! Wow! electrifying environment here. I am still remembering the back heel flick of Suman Lama, just like Cristiano Ronaldo!Huuuuuuuuuuuu! You lovely boy!
	21 '	Dangerous, India on attack! Daniel flicks the ball luckily, it angles away, Total luck to Nepal... Comeon Nepalese colts, you need to mark the striker well!
	20 '	GOAL..GOAL.GOAL!!!!!!! What a GOAL for Nepal.. Credit goes to Suman Lama, what a nimble show, just like Christianon Ronaldo, but it hits the bar and Rishi Thapa Magar is right there to place the ball. GOAL.GOAL!!! Nepal are 1-0 up! GOAL Rishi Thapa Magar
	18 '	Oh hooo., dangerous but luck to Nepal, Sanjaya Rajbahak slides to tackle the ball but it hits the leg of Daniel, Nepalese goalie, Birendra is out from his position but he manages to catch the ball. Phewwwwww!
	17 '	Daniel of India is looking dangerous, Nepalese boys need to makr him properly. Lovely Biswash, what a neat pass to Rishi, Can he score from that position, not more than 20 yard, powerful shot but goes little wide.
	16 '	counter move by Indians, Daniel is well challenged by Sanjaya Rajbahak, what a tackle, lovely! Good job Rajbahak.
	14 '	Rishi Thapa magar is fouled by Raja Rawat, referee gives a foul kick to Nepal. wow, Nepal..Nepal..Aditya Choudhary steps in to kick the ball, he's got power in his legs, shoots powerfully but the ball skies over the ball.
	12 '	Indian coaches are asking their goalie, Supratim to shoot long ball to Nepal D box, I can see Indian coaches instructing their goalie!
	11 '	Sagar Lama fouls on Lalram, referee whistles for a foul, Raja Rawat is ready with the ball, Nepalese goalie, Birendra Chand is shouting at his boys, Rawat curls the ball, well caught by Chand.
	10 '	Indians are playing aerial ball. Off side trap here by Nepalese boys and Laldanta Sanga is caught! this could be dangerous.
	8 '	Shorter Nepalese boys are holding the ball possession, Indians are looking for counter moves from the start. Aww, our senior team coach, Graham Roberts is shouting at the boys! Rishi..Rishi...
	6 '	Biswas shrestha is in the left field, crosses the ball to Suman and Rishi but the ball curls out. Nepalese boys are putting Indians udner pressure.
	5 '	Good pass by Rishi to Suman Hamal, Myron tackles the ball well. Good start by both teams.
	4 '	First corner kick of the match, Nepal earns it, Nepal..Nepal..everywhere, Heman Gurung is ready with the ball, Sajid clears the ball from D-box.
	3 '	India: Supratim (GK), Myron, Suman, Sajid, Nabin, Kamalpreet, Germanpreet, Lalram, Raja, Daniel, Laldanta
	2 '	Nepal : Heman, Aditya, Sanjaya, Anil, Birendra (GK), Umesh, Rishi, Bibek, Biswas, Sagar, Suman
	1 '	Peeeep! here we go. Nepal U-16 vs India U-19/ Watch LIVE video at www.goalnepal.com.np. Mizamizanpur from Bangladesh is the man in charge.
		Wow..Nepal..Nepal already! Nepal are in red shirts while Indians are in blue shirts.
		Both teams are under tunnel, ready for the match. Here echoes the FIFA anthem.
		Pakistan won the match against Bangladesh and are through to final. Nepalese colts are ready to do the same.
		Hello, big match here at Dasrath Stadium. More than 5000 spectators are here supporting Nepal...only Nepal! Stay with us, we are 10 mins away to kick off the match.