Secretory diarrhea

Another nutritional issue concerns the crypts. Certain bacterial and viral infections can provoke vast increases in the secretory activity of the crypts, resulting in excessive losses of salts and water, as well as diarrhea. Secretory diarrheas that continue for a week or longer may be life threatening, as discussed in Chapter 10 in the section on Sodium, Potassium, and Water. 

USP (Sandostatiu) flutamide (Rulexin) [13311-84-7] C11H11F3N2O3 276.21 (66) tumors vasoactive intestinal peptide-secretory tumors metastatic prostatic stools vomit-ing abdomiaal pain pain on iujection diarrhea... 

Opiates and various derivatives are commonly used to treat diarrhea, partly because they inhibit electrolyte secretion (Suzuki et al., 2000 Tumberg, 1983). Other phytochemicals counter the secretory responses to cholera toxin (Oi et al., 2002). An example would be the decreased chloride secretion caused by proanthocyanide and the ability to inhibit the secretory diarrhea caused by cholera toxin, but only if administered first (Hor et al., 1995). In the light of the co-transport of water and electrolytes by carriers of glucose... 

Vomiting, nasogastric suctioning, and chloride (secretory) diarrhea (villous adenoma or laxative abuse)... 

The use of non-sulfapyridine-based aminosalicylates has led to greater tolerability. Although the adverse effects are similar to those of sulfasalazine, they occur at a much lower rate. Olsalazine, in particular, is associated with a higher incidence of secretory diarrhea. These agents can also be used safely in patients with a reported sulfonamide allergy. 

Secretory diarrhea results in an increase in the net movement (secretion) of ions into the intestinal lumen leading to an increase in intraluminal fluid. Medications, hormones, and toxins may be responsible for secretory activity. 

Although diarrhea can often be attributed to a specific mechanism, some patients develop diarrhea due to overlapping mechanisms. For example, malabsorption syndromes and traveler s diarrhea are associated with both secretory and osmotic diarrhea. 

Stool volume and electrolytes can be assessed in large-volume watery stools to determine whether the diarrhea is osmotic or secretory. 

Lima AA, Carvalho GH, Figueiredo AA, Gi-foni AR, Soares AM, Silva EA, Guerrant RL Effects of an alanyl-glutamine-based oral rehydration and nutrition therapy solution on electrolyte and water absorption in a rat model of secretory diarrhea induced by cholera toxin. Nutrition 2002 18 458-462. 

Alvisi et al. [28] randomized, active drug-controlled, double-blind adults acute secretory diarrhea various nonclassic enteric flora 22 800 mg/day (5 days) neomycin 21 1 g/day (5 days)... 

The most widely studied therapeutic proteins produced in plants include monoclonal antibodies for passive immunotherapy and antigens for use as oral vaccines [40]. Antibodies against dental caries, rheumatoid arthritis, cholera, E. coli diarrhea, malaria, certain cancers, Norwalk virus, HIV, rhinovirus, influenza, hepatitis B virus and herpes simplex virus have been produced in transgenic plants. However, the anti-Streptococcus mutans secretory antibody for the prevention of dental caries is the only plant-derived antibody currently in Phase II clinical trials [40]. Until recently, most antibodies were expressed in tobacco, potato, alfalfa, soybean, rice and wheat [9], It has been estimated that for every 170 tons of harvested tobacco, 100 tons represents harvested leaves. A single hectare could thus yield 50 kg of secretory IgA [3, 41]. Furthermore, it has been estimated that the cost of antibody production in plants is half that in transgenic animals and 20 times lower than in mammalian cell cul-... 

Secretory diarrhea occurs when a stimulating substance (e.g., vasoactive intestinal peptide [VIP], laxatives, or bacterial toxin) increases secretion or decreases absorption of large amounts of water and electrolytes. 

ETEC is capable of producing two plasmid-mediated enterotoxins heat-labile toxin and heat-stable toxin. The net effect of either toxin on the mucosa is production of a cholera-like secretory diarrhea. 

Causes of diarrhea (in red) Many bacteria (e.g., Vibrio cholerae) secrete toxins that inhibit the ability of mucosal ente-rocytes to absorb NaCl and water and, at the same time, stimulate mucosal secretory activity. Bacteria or viruses that invade the gut wall cause inflammation characterized by increased fluid secretion into the lumen. The enteric musculature reacts with increased peristalsis. 

The clinical picture of carbaryl intoxication results from inactivation of cholinesterase, resulting in the accumulation of acetylcholine at synapses in the nervous system, skeletal and smooth muscle, and secretory glands. Signs and symptoms of overexposure may include (1) muscarinic manifestations such as miosis, blurred vision, lacrimation, excessive nasal discharge or salivation, sweating, abdominal cramps, nausea, vomiting, and diarrhea (2) nicotinic manifestations including fasiculation of fine muscles and tachycardia and (3) central nervous system manifestations characterized by headache, dizziness, mental confusion, convulsions, coma, and depression of the respiratory center. 

Porter, and J. S. Fordtran. Effect of psyllium, calcium polycarbophil, and wheat bran on secretory diarrhea induced by phenolphthalein. Gastroenterology 1993 104(4) 1007-1012. Colliopoulos, J. Psyllium-based laxative compositions. Patent-US-5,232, 699 1993 6 p. 

Unlabeled Uses Control of bleeding esophageal varices, treatment of AIDS-associated secretory diarrhea, chemotherapy-induced diarrhea, insulinomas, small-bowel fistulas, control of bleeding esophageal varices... 

Dicyclomine Competitive antagonism at M3 receptors Reduces smooth muscle and secretory activity of gut Irritable bowel syndrome, minor diarrhea Available in oral and parenteral forms short t1/2 but action lasts up to 6 hours Toxicity Tachycardia, confusion, urinary retention, increased intraocular pressure Interactions With other antimuscarinics... 

Two gastrointestinal neuroendocrine tumors (carcinoid, VIPoma) cause secretory diarrhea and systemic symptoms such as flushing and wheezing. For patients with advanced symptomatic tumors that cannot be completely removed by surgery, octreotide decreases secretory diarrhea and systemic symptoms through inhibition of hormonal secretion and may slow tumor progression. 

Beckman RA, Siden R, Yanik GA, Levine JE. Continuous octreotide infusion for the treatment of secretory diarrhea caused by acute intestinal graft-versus-host disease in a child. J Pediatr Hematol Oncol 2000 22(4) 344—50. 

Conjugated bile salts are normally absorbed in the terminal ileum. Disease of the terminal ileum (eg, Crohn s disease) or surgical resection leads to malabsorption of bile salts, which may cause colonic secretory diarrhea. The bile salt binding resins cholestyramine or colestipol may decrease diarrhea caused by excess fecal bile acids (see Chapter 35 Agents Used in Hyperlipidemia). The usual dose is 4-5 g one to three times daily before meals. Side effects include bloating, flatulence, constipation, and fecal impaction. In patients with diminished circulating bile acid pools, further removal of bile acids may lead to an exacerbation of fat malabsorption. These agents bind a number... 

Originally isolated from the hypothalamus, somatostatin is a small polypeptide that is also found in neurons throughout the body, as well as in the intestine and pancreas. Somatostatin therefore predictably has a number of actions. Octreotide [awk TREE oh tide] is a synthetic octapeptide analog of somatostatin. It has a much longer half-life than the natural compound and has found use in the treatment of acromegaly caused by hormone-secreting tumors, and secretory diarrhea associated with tumors producing the vasoactive intestinal peptide (VIP). Adverse effects of octreotide treatment are flatulence, nausea, and steatorrhea. 

Shook JE, Burks TF, Wasley JWF, Norman JA (1989) Novel calmodulin antagonist CGS 9343B inhibits secretory diarrhea. J Pharmacol Exp Ther 251 247-252... 

Gastrointestinal Abdominal pain, secretory diarrhea, dyspepsia, nausea... 

Four general pathophysiologic mechanisms disrupt water and electrolyte balance, leading to diarrhea. These four mechanisms are the basis of diagnosis and therapy. They are (1) a change in active ion transport by either decreased sodium absorption or increased chloride secretion (2) a change in intestinal motility (3) an increase in luminal osmolarity and (4) an increase in tissue hydrostatic pressure. These mechanisms have been related to four broad clinical diarrheal groups secretory, osmotic, exudative, and altered intestinal transit. 

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