Diarrhoea CCC
OVERVIEW
- common in ICU
- pathophysiology: secretory, motor, exudative, osmotic
CAUSES
Infective
- Pseudomembranous colitis (Clostridium difficile) – see specific document
Other bacterial colitis:
- Staphylococcal enterocolitis and typhilitis
- Campylobacter species
- Clostridium perfringens
- Samonella species
- Shigella species
- Escherichia coli
- Yersina species
- Entamobeba histolytica
HIV
Non-infective
- Enteral feed associated – site, mode of administration and composition
- Ischaemic colitis
- Chemical colitis
- Gut dysmotility
- Hypoalbuminaemia
- Acute exacerbation of Crohn’s or UC
Other Risk Factors
- fever or hypothermia
- presence of an infection
- malnutrition
- hypoalbuminaemia
- sepsis syndrome
- MODS
- previous TPN
CONSEQUENCES
- malnutrition
- haemodynamic instability
- metabolic acidosis (loss of electrolytes and HCO3-)
- hypokalaemia
- hypomagnesaemia
- low zinc
- impaired wound healing
- arrhythmias
MANAGEMENT
Resuscitation
- IV rehydration (Na+ and glucose containing solutions)
Acid-base and Electrolytes
Specific Therapy
- primary diarrhoea: only indicated in the really sick -> ciprofloxacin or norfloxacin
- antibiotic induced diarrhoea: metronidazole
- can consider oral opioids or anti-diarrhoeal’s: loperamide or codeine
- enteral feeds with low osmolarity and enriched with fiber
- probiotics: viable microorganisms which help host
- prebiotics: non-digestable food ingredient that selects helpful bacteria in the colon
- synbiotics: both probiotics and prebiotics
Underlying Cause
- stop offending drugs/antibiotics
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC