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

CCC 700 6

Critical Care

Compendium

Chris is an Intensivist and ECMO specialist at the Alfred ICU in Melbourne. He is also the Innovation Lead for the Australian Centre for Health Innovation at Alfred Health and Clinical Adjunct Associate Professor at Monash University. He is a co-founder of the Australia and New Zealand Clinician Educator Network (ANZCEN) and is the Lead for the ANZCEN Clinician Educator Incubator programme. He is on the Board of Directors for the Intensive Care Foundation and is a First Part Examiner for the College of Intensive Care Medicine. He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives.

After finishing his medical degree at the University of Auckland, he continued post-graduate training in New Zealand as well as Australia’s Northern Territory, Perth and Melbourne. He has completed fellowship training in both intensive care medicine and emergency medicine, as well as post-graduate training in biochemistry, clinical toxicology, clinical epidemiology, and health professional education.

He is actively involved in in using translational simulation to improve patient care and the design of processes and systems at Alfred Health. He coordinates the Alfred ICU’s education and simulation programmes and runs the unit’s education website, INTENSIVE.  He created the ‘Critically Ill Airway’ course and teaches on numerous courses around the world. He is one of the founders of the FOAM movement (Free Open-Access Medical education) and is co-creator of litfl.com, the RAGE podcast, the Resuscitology course, and the SMACC conference.

His one great achievement is being the father of two amazing children.

On Twitter, he is @precordialthump.

| INTENSIVE | RAGE | Resuscitology | SMACC

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