Diarrhea adsorbents

Drugs Useful for Treating Diarrhea Adsorbents and Bulking Agents... 

Adsorbents coat the wall of the GI tract and adsorb bacteria or toxins that are causing the diarrhea. Adsorbents include kaolin and pectin, which are combined in the over-the-counter drug Kaopectate, and other antidianheals. Pepto-Bismol is considered an adsorbent because it adsorbs bacterial toxins. Bismuth salts can also be used for gastric discomfort. Colestipol and cholestyramine (Questran) are prescription drags that have been used to treat diarriiea. 

Magnesium trisihcate is a nonsystemic antacid and an adsorbent. It has a slow onset of activity and is a relatively weak antacid. It may cause diarrhea in large doses owing to soluble magnesium salts. One gram of magnesium trisihcate neutralizes 10 mL of 0.1 NUCl in 10 min, and 15 mL in 2 h. 

ANTIFLATULENTS. Activated charcoal can adsorb drugs while they are in the GI tract. The nurse administers charcoal 2 hours before or 1 hour after other medications. If diarrhea persists or lasts longer than 2 days or is accompanied by fever, the nurse notifies the primary care provider. Simethicone is administered after each meal and at bedtime... 

Attapulgite adsorbs excess fluid in the stool with few adverse effects. Calcium polycarbophil is a hydrophilic polyacrylic resin that also works as an adsorbent, binding about 60 times its weight in water and leading to the formation of a gel that enhances stool formation. Neither attapulgite nor polycarbophil is systemically absorbed. Both products are effective in reducing fluid in the stool but can also adsorb nutrients and other medications. Their administration should be separated from other oral medications by 2 to 3 hours. Psyllium and methylcellulose products may also be used to reduce fluid in the stool and relieve chronic diarrhea. 

Various drugs have been used to treat diarrhea (Table 23-4). These drugs are grouped into several categories antimotility, adsorbents, antisecretory compounds, antibiotics, enzymes, and intestinal microflora. Usually, these drugs are not curative but palliative. 

Nonspecific antidiarrheal agents may be useful in treating self-limiting diarrhea. Kaolin and pectin or chalk may adsorb noxious compounds but evidence that such adsorbents are effective is unconvincing. Disadvantages can be prolongation of the course of infection and interference with absorption of desired drugs. 

KaoUn powder and other hydrated aluminum silicate clays, often combined with pectin (a complex carbohydrate), are the most widely used adsorbent powders (e.g., Kaopectate). Kaolin is a naturally occurring hydrated aluminum silicate that is prepared for medicinal use as a very finely divided powder. The rationale behind its use in acute nonspecific diarrhea stems from its ability to adsorb some of the bacterial toxins that often cause the condition. It is almost harmless and is effective in many cases of diarrhea if taken in large enough doses (2-10 g initially, followed by the same amount after every bowel movement). The adsorbents are generally safe, but they may interfere with the absorption of some drugs from the GI tract. 

Adsorbents such as kaolin, pectin, or attapulgite are administered to take up and hold harmful substances such as bacteria and toxins in the intestinal lumen.44 Theoretically, these adsorbents sequester the harmful products that cause the diarrhea. These products are used frequently in minor diarrhea, although there is some doubt as to whether they really help decrease stool production and water loss. 

Adsorbents used to treat diarrhea are listed in Table 27-3. These agents frequently appear as the active ingredients in over-the-counter products and may be combined with each other or with other drugs such as antacids. 

Increased motility of the gastrointestinal tract and decreased absorption of fluid are major factors in diarrhea. Antidiarrheal drugs include antimotility agents, adsorbents, and drugs that modify fluid and electrolyte transport (Figure 24.8). 

Attapulgite is widely used as an adsorbent in solid dosage forms. Colloidal clays (such as attapulgite) absorb considerable amounts of water to form gels and in concentrations of 2-5% w/v usually form oil-in-water emulsions. Activated attapulgite, which is attapulgite that has been carefully heated to increase its absorptive capacity, is used therapeutically as an adjunct in the management of diarrhea. 

Pectin has been used as an adsorbent and bulk-forming agent, and is present in multi-ingredient preparations for the management of diarrhea, constipatiom and obesity it has also been used as an emulsion stabilizer. ... 

Bismuth subsalicylate (BSS) is used widely in humans for treatment of diarrhea and is specifically recommended for the prevention of traveler s diarrhea. The precise mechanism of action remains undetermined and although the end result of treatment with BSS is reduction in diarrhea (Figueroa-Quintanilla et al 1993), its effect is probably not related to a direct antisecretory mechanism. Salicylates have been shown to stimulate intestinal fluid and electrolyte absorption per se but it is likely that, in many cases of colitis, resolution of inflammation and restoration of a normal surface epithelium is required to restore mucosal function. When used as pretreatment or coadministered, BSS significantly reduced the fluid secretory response to E. coli LT enterotoxin and cholera toxin in intestinal loops of rabbits and pigs (Ericsson et al 1990). However, when administered even 5 min after the enterotoxins, BSS had no significant effect on enterotoxin-stimulated intestinal secretion. These results suggest that BSS adsorbs or neutralizes bacterial enterotoxins but does not alter the effect of enterotoxins once they have bound to intestinal mucosa. BSS also modulates normal... 

Adsorbents Adsorbents coat the GI tract, adsorbing the bacteria or toxins that cause diarrhea. Commonly used adsorbents are ... 

The constipating effect of orally administered opiates can be used for the treatment of diarrhea, as with camphorated tincture of opium (Paregoric or Parepectolin, which is a paragoric plus kaolin as an adsorbent and pec-... 

Adsorbents have long been employed to treat various intestinal disturbances. In 1712, Father Deutrecolle, a Jesuit missionary in China, described the use of clay to treat diarrhea.42 Braafladt reports that the use of kaolin together with a hypertonic salt solution reduced the mortality from cholera from 60 to 3 % during the Balkan war of 1910.42 McRobert advocated kaolin to treat acute... 

Bismuth Subsalicylate (Pepto-Bismol) Adsorbs toxins produced by bacteria and other Gl irritants. Diarrhea. Prophylaxis for traveler s diarrhea. Large dose requirements limit utility for long trips. Impaction. 

Kaolin/Pectin (Kaopectate) Adsorbant and protectant of questionable efficacy. Diarrhea. May t K loss or interfere with absorption of drugs and nutrients. 

The answer is 5 /If B 3 c (2)J. Sorbitol acts as an osmotic cathartic by attracting water to the intestinal lumen. Overuse may result in excessive Intestinal fluids and diarrhea. The use of sorbitol speeds the passage of gastroirv testinal contents and toxicarTts adsorbed to charcoal, thus removing them from the intestine rapidly and helping to prevent the constipation that may be caused by oral charcoal. 

Kaolin is distributed worldwide in nature, but is frequently contaminated with impurities, and must be purified for use in pharmaceuticals. It is used alone or as a mixture with pectin. It is of value primarily in the treatment of diarrhea caused by agents capable of being adsorbed, such as diarrhea caused by dysentery or food poisoning. 

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