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Diarrhea (Acute)
Published in Charles Theisler, Adjuvant Medical Care, 2023
Adsorbents such as kaolin-pectin (30–120 mL after each loose stool), bismuth sub-salicylate (see Pepto-Bismol above), and attapulgite (1,200–1,500 mg after each loose bowel movement or every 2 hours, up to 9,000 mg/day) absorb fluid to help manage diarrhea.
Symptom Control in Hospice-State of the Art
Published in Inge B. Corless, Zelda Foster, The Hospice Heritage: Celebrating Our Future, 2020
J. Cameron Muir, Lisa M. Krammer, Jacqueline R. Cameron, Charles F. von Gunten
Beyond reversing the underlying etiology, the general treatment of diarrhea includes supportive measures such as replenishing fluid if dehydration is suspected (oral route preferred) and initiating a diet of clear liquids and simple carbohydrates. Persistent diarrhea may require antidiarrheal agents. These agents are classified as absorbent, adsorbent, mucosal prostaglandin inhibitors and opioids. Absorbent agents (methyl cellulose) absorb water to form a colloidal mass. Adsorbent antidiarrheal medications (attapulgite) non-specifically adsorb dissolved substances such as bacteria, toxins, and water. These two categories are only modestly effective for patients with continuous large-volume diarrhea. Mucosal prostaglandin inhibitors (bismuth sub-salicylate) reduce water and electrolyte secretion from the intestinal wall. Opioid agents (e.g., loperamide) decrease peristalsis in the colon by way of specific intestinal receptors. The addition of anticholinergic agents (such as atropine) with an opiate (diphenoxylate) may provide additional benefit, but may also cause cramping. Additionally, secretory diarrhea (such as from chemotherapy or HIV) has been successfully treated with octreotide.39,40 Future research into broader applications of octeotride as well as such novel agents as peptide YY (also thought to reduce intestinal fluid secretion) is needed.
Control of symptoms other than pain
Published in Nigel Sykes, Michael I Bennett, Chun-Su Yuan, Clinical Pain Management, 2008
Emma Hall, Nigel Sykes, Victor Pace
There is limited evidence for the efficacy of certain adsorbent and absorbent substances in acute diarrhea (e.g. pectin119[II] or attapulgite120[II]). The most effective general antidiarrheals are the opioids, of which loperamide is the most specific, as in adults it has an oral bioavailability close to 1 percent and hence its effects are limited almost exclusively to the gut.121[V]
Clay nanoparticles as pharmaceutical carriers in drug delivery systems
Published in Expert Opinion on Drug Delivery, 2021
Jiani Dong, Zeneng Cheng, Songwen Tan, Qubo Zhu
This review aims to summarize the current and emerging applications of clay nanoparticles as pharmaceutical carriers in drug delivery systems. We focus on describing the general properties of different morphologies of nanoclay minerals, including crystal structure, surface charge, and drug loading mechanism, and then select the typical work published in recent years for a detailed description. Firstly, we report the advanced applications of natural nanoclays with different morphologies in the pharmaceutical field. Montmorillonite and kaolinite are considered as clay nanoplates while halloysite is a promising nanotubular biocompatible material. Fibrous clay minerals, attapulgite, and sepiolite are also discussed as materials with large surface area. The second part of the review is focused on synthetic nanoclays, which mainly include mesoporous silica laponite and imogolate. At last, the advantages and limitations of these nanoclay materials are discussed, and the perspectives for further study are pointed out.
Evaluating the cost utility of racecadotril in addition to oral rehydration solution versus oral rehydration solution alone for children with acute watery diarrhea in four low middle-income countries: Egypt, Morocco, Philippines and Vietnam
Published in Journal of Medical Economics, 2022
Tamlyn Anne Rautenberg, Martin Downes, Pham Huy Tuan Kiet, Nermeen Ashoush, Antonio Rosete Dennis, Kyoo Kim
A further strength is that the model structure represents the clinical situation at the country level. In contrast to other medical conditions, there is almost universal agreement on clinical management and for the last three decades, international guidelines recommend ORS as the standard of care12–14,18. Once clinical features of dehydration are present, children are admitted to the hospital. This agreement in clinical scenarios across a wide range of high, upper-middle- and low-income countries means that the core model is highly amenable to adaptation to a wide range of countries because the inherent structure of the model is transferable to most clinical outpatient and inpatient settings. For example, in Egypt, a new consensus guideline for children with Acute Gastroenteritis recommends that primary care physicians evaluate the hydration status of children under five, and confirms that children with no dehydration can be managed at home and children at high risk of developing dehydration should be hospitalized15. Similarly in the Philippines, according to the Clinical Practice Guidelines of the Department of Health (2019), children with mild to moderate dehydration are treated with ORS, whereas, children with severe dehydration are given rapid intravenous rehydration18. The model aligns with both of these guidelines. In the Philippines, the Philippine Health Insurance Corporation (PhilHealth) is the national single-payer for all hospital admissions and sets out acceptable interventions for inpatients and case rates16. Children admitted with diarrhea are reimbursed by PhilHealth with 6,000 PHP with a minimum length of stay of 3 days51. ORS and intravenous fluids are the standard treatment for dehydration caused by diarrhea and are administered based on the degree of dehydration16. The document states that the use of non-formulary "anti-diarrheal" drugs has no proven benefit and is not indicated for acute diarrhea16. These include adsorbents such as kaolin, activated charcoal, cholestyramine, attapulgite and antimotility drugs including loperamide hydrochloride and diphenoxylate. Use of these non-formularies is penalized with non-payment of case rates16.