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Suggest treatment for chronic diarrhea in an elderly person

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Posted on Fri, 29 Jul 2016
Question: My mother age 73 yrs is suffering from loose (watery) motion 2-3 times in a day especially after meal at night stool is smelling fouling odour she is not resposding to metrogyl and responds to diet modification she is paralyzed, epileptic, dibetic but Sugar is normal, catheterized and bed ridden from last 3 yrs she is currently taking
phenytoin50 BD
Levitracetam 250 TDS.
Ranitidine 150 BD
Clopidogrel+Asprin75mg OD
Atorvastatin10mg OD
Kindly suggest treatment for watery chronic diarrhoea she is also having cough kindly go through reports LFT,KFT,TFT,CBC
doctor
Answered by Dr. Prof. Kunal Saha (6 hours later)
Brief Answer:
It is probably not an infective diarrhea

Detailed Answer:
Thanks for asking on HealthcareMagic.

Most often diarrhea is due to viral cause where antibiotics and metrogyl (metronidazole) are ineffective. The rest are bacterial but unless associated with bloody stool, treatment with antibiotics is not essential and metrogyl once again is not applicable. It is only in less than 5% cases that the diarrhea is due to amebic or parasitic causes where metrogyl is effective. So, it is a really bad practice to self medicate with metrogyl. What actually happens is that the diarrhea resolves on its own in 3-5 days and you credit metrogyl for the same.

Sorry for the long introduction, but you should not expect any improvement with metrogyl. The mainstay of treatment is ORS (oral rehydration solution) to make up for the salt and water loss. The body will take care of the rest.

In case of recurrent diarrhea (what you mean by chronic diarrhea), the problem is surely not infective. Rather, the body is reacting to some common thing (dietary principle) and revolting against it. Gluten is the commonest cause. Try restricting all wheat and wheat related products for at least 2 weeks and see if that makes a difference.

For cough, ask her to take steam inhalation. Water in form of vapor reaches deep inside and helps in diluting the cough and thus provides relief. Also give her some antiallergic like cetirizine once daily for the next few days.

Let me know if I could be of further assistance.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Prof. Kunal Saha (31 hours later)
Dear Sir,
Thanks for ur prompt response but the loose motion is not controlled from last one month now diet modification is also not working . she is having watery stool in the morning, evening and after taking meal at night and also have abdominal pain which relives after defection. kindly go through reports and suggest possible treatment
doctor
Answered by Dr. Prof. Kunal Saha (4 hours later)
Brief Answer:
Gluten and lactose restriction.

Detailed Answer:
Thanks for writing back and for clarifying. Please clarify if she has been given a gluten free diet, and if so, for how long. Also mention if complete elimination of milk and related products has been tried. These two are very important for her.

Going through the following links should be helpful:
http://www.uptodate.com/contents/chronic-diarrhea-in-adults-beyond-the-basics
http://patient.info/doctor/chronic-diarrhoea-in-adults

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
doctor
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Follow up: Dr. Prof. Kunal Saha (2 days later)
Dear sir,
My mother's BP has fallen down to 64/ 40 in the afternoon after giving aceclofenac + paracetamol + serasiopeptidase she had chills to control chills she was given pheniramin maleate 30 mg from afternoon she is sleeping and her BP is falling even after giving ORS kindly suggest she has been seen by dr. He sugested to give ORS but there is no rise in BPBP distolic is constant on 40
doctor
Answered by Dr. Prof. Kunal Saha (1 hour later)
Brief Answer:
Hospitalization might be required

Detailed Answer:
Thanks for writing back.
The condition worries me. The fall in BP indicates that the fluid supplementation has not been adequate and ORS needs to be given properly. The BP needs to be monitored and depending upon the scenario hospitalization might also be required.

Regards
Above answer was peer-reviewed by : Dr. Chakravarthy Mazumdar
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Answered by
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Dr. Prof. Kunal Saha

General & Family Physician

Practicing since :1954

Answered : 4472 Questions

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Suggest treatment for chronic diarrhea in an elderly person

Brief Answer: It is probably not an infective diarrhea Detailed Answer: Thanks for asking on HealthcareMagic. Most often diarrhea is due to viral cause where antibiotics and metrogyl (metronidazole) are ineffective. The rest are bacterial but unless associated with bloody stool, treatment with antibiotics is not essential and metrogyl once again is not applicable. It is only in less than 5% cases that the diarrhea is due to amebic or parasitic causes where metrogyl is effective. So, it is a really bad practice to self medicate with metrogyl. What actually happens is that the diarrhea resolves on its own in 3-5 days and you credit metrogyl for the same. Sorry for the long introduction, but you should not expect any improvement with metrogyl. The mainstay of treatment is ORS (oral rehydration solution) to make up for the salt and water loss. The body will take care of the rest. In case of recurrent diarrhea (what you mean by chronic diarrhea), the problem is surely not infective. Rather, the body is reacting to some common thing (dietary principle) and revolting against it. Gluten is the commonest cause. Try restricting all wheat and wheat related products for at least 2 weeks and see if that makes a difference. For cough, ask her to take steam inhalation. Water in form of vapor reaches deep inside and helps in diluting the cough and thus provides relief. Also give her some antiallergic like cetirizine once daily for the next few days. Let me know if I could be of further assistance. Regards