Stool water losses

A common response to fish poisoning is diarrhea, often in the form of loose and watery stools accompanied with excessive water loss. However, in some special cases, the uncontrollable urge of bowel movements and discharges do not involve a noticeable loss of water. In those cases, oil is discharged or leaked through the rectum, and this type of poisoning responses is called keriorrhea or keriorrhoea. 

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. 

Normal faeces contain 60-85% water, and the body loses between 70 and 200 ml of water per day through defecation. In diarrhoea, water loss of up to four times this volume per loose stool occurs, and sodium and potassium alkaline salts are excreted along with it, leading to a fall in plasma pH (acidosis). This can have serious metabolic consequences, particularly in the very young and the elderly. Fluid and electrolyte losses are increased if vomiting also occurs. 

Patients with diarrhea should be questioned about the onset of symptoms, recent travel, diet, source of water, and medication use. Other important considerations include duration and severity of the diarrhea along with an accounting of the presence of associated abdominal pain or vomiting, blood in the stool, stool consistency, stool appearance, stool frequency, and weight loss. Although most cases of diarrhea are self-limited, infants, children, elderly persons, and immunocompromised patients are at risk for increased morbidity. 

The synthesis of [Ircp Cl(bpy-cd)]Cl, where bpy-cd is a /3-cyclo-dextrin attached at the 6 position to a bpy ligand, is detailed.138 The complexes [Ircp (diimine)X]+, X = C1, H, diimine = bpy, phen, are active catalysts for the light-driven water-gas-shift reaction.139 The hydride complexes luminesce at 77 K and room temperature, whereas the chloride complexes do not.140 The three-legged piano-stool arrangement of the ligands in [Ircp (bpy)Cl]+ and [Ircp (4,4 -COOFl-bpy)Cl]+ is confirmed by X-ray crystallography.141,142 Further mechanistic studies on the catalytic cycle shown in reaction Scheme 11 indicate that Cl- is substituted by CO and the rate-determining step involves loss of C02 and H+ to leave the Ir1 species, which readily binds Fl+ to yield the lrIH hydride species.143... 

Vibrio cholerae. The cause of death in cholera is electrolyte and fluid loss in the stools and this may exceed 11/h. The most important aim of treatment is prompt replacement and maintenance of water and electrolytes with oral or intravenous electrolyte solutions. Doxycycline, given early, significantly reduces the amount and duration of diarrhoea and eliminates the organism from the faeces (thus lessening the contamination of the environment). Carriers may be treated by doxycycline by mouth in high dose for 3 days. Ciprofloxacin may be given for resistant organisms. 

Oral rehydration therapy (ORT) with glucose-electrolyte solution is sufficient to treat the vast majority of episodes of watery diarrhoea from acute gastroenteritis. As a simple, effective, cheap and readily administered therapy for a potentially lethal condition, ORT must rank as a major advance in therapy. It is effective because glucose-coupled sodium transport continues during diarrhoea and so enhances replacement of water and electrolyte losses in the stool. 

Eluid replacement ORT 50 mL/kg over 2-i h Replace ongoing losses with low-sodium ORT (40-60 mEg/L Na+) at 10 mL/kg per stool or emesis ORT 100 mL/kg over 2-4 h Replace ongoing losses with low-sodium ORT (40-60 mEq/L Na+) at 10 mL/kg per stool or emesis Ringer lactate 40 mL/kg in 15-30 min, then 20-40 mL/kg if skin turgor, alertness, and pulse have not returned to normal or Ringer lactate or NS 20 mL/kg, repeat if necessary, and then replace water and electrolyte deficits over 1-2 days Eollowed by ORT 100 mL/kg over 4 hours. Replace ongoing losses with low-sodium ORT (40-60 mEq/L Na+) at 10 mL/kg per stool or emesis... 

Loperamide hydrochloride is an antidiarrheal agent that slows intestinal motility, affects water and electrolyte movement through intestine, inhibits peristalsis, reduces daily fecal volume, increases viscosity and bulk density of stool, and diminishes loss of fluid and electrolytes. It is indicated in the control and symptomatic relief of acute nonspecific or chronic diarrhea and in the reduction in volume of ileostomy output. 

Dennis Veere has become dehydrated because he has lost so much water through vomiting and diarrhea (see Chapter 4). Cholera toxin increases the efflux of sodium and chloride ions from his intestinal mucosal cells into the intestinal lumen. The increase of water in his stools results from the passive transfer of water from inside the cell and body fluids, where it is in high concentration (i.e., intracellular Na+ and Cl concentrations are low), to the intestinal lumen and bowel, where water is in lower concentration (relative to high Na+ and Cl ). The watery diarrhea is also high in K+ ions and bicarbonate. All of the signs and symptoms of cholera generally derive from this fluid loss. 

Fig. 9. The water requirement and tolerance of the infant as compared with those of the adult. Note that the infant s minimal water requirement is increased by relatively larger insensible and stool losses and an appreciable diversion of water to new protoplasm for growth. The water tolerance of the neonate is reduced by a slight reduction in the renal capacity to dilute accompanied by a substantially prolonged time for adaptation to a water load. Tolerance is also variably reduced by diet breast milk, for example, limits water excretion capacity because of its very small osmoti-cally active residue. (Talbot, 1959).

Laxatives—Drugs such eis atropine and diuretics may make some people constipated, so laxatives may sometimes be added to such mixed medications. Some misinformed people also use excessive amounts of laxatives to cause weight loss which results in an increeised loss of nutrients and water in the stool. 

Diarrhea—Bacteria, viruses, or parasites can cause diarrhea, which depletes the body of nutrients and fluids. Loose watery stools are accompanied by nausea, abdominal cramps, and vomiting. Oral rehydration treatment acts to replenish fluid loss and rectify electrolyte imbalances. Different types of diarrhea include travelers diarrhea, normally caused by Escherichia coli bacterial dysentery (shigellosis), an acute bacterial infection of the large intestine amoebic dysentery, where cysts of infecting organisms are transmitted through food and water and giardiasis, caused by parasites that infect the small intestine. 

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