▪︎ابتدا درباره علل شایع و clueهایی که بهمون کمک میکنه(زمان و نوع انتقال و..) صحبت میکنیم و بعدش درباره گاستروانتریت ویروسی( اسهال رو توی یه مبحث جدا صحبت میکنیم بعدا ایشالا).
▪︎گاستروانتریت عفونی شکایت شایعی که باعث میشه بیمارا اورژانس(اغلب سرپایی) مراجعه کنند. که اغلب self-limited هست و اساس درمانش مایع دادن(ORS و اگه نتونست بخوره یا severe hypovolemia باشه یا... میریم سمت iv fluid therapy) و ساپورتیو هست.
▪︎مهمه که "alarm signs" رو بدونیم چون نیاز به ارزیابی بیشتر و شاید بستری داشته باشند.
▪︎بصورت کلی بخوایم گاستروانتریت رو تعریف کنیم:
Acute gastroenteritis is defined as diarrheal disease (three or more times per day or at least 200 g of
stool per day) of rapid onset that lasts less than two weeks and may be accompanied by nausea, vomiting, fever, or abdominal pain. Classically, vomiting and diarrhea occur together; however, less commonly, either can occur alone.
▪︎ علت شایع هم میشه ویروسی(نوروویروس):
Most cases of acute infectious gastroenteritis are viral, with norovirus being the most common cause of acute gastroenteritis and the second most common cause of hospitalization for acute gastroenteritis.
پس همینجا متوجه میشیم که اکثرا آنتی‌بیوتیک نیاز نیست مگر تحت شرایط خاصی.
▪︎Antibiotics — In adults who clearly have acute viral gastroenteritis (eg, outbreak with known etiology), we do not recommend the empiric use of antibiotics. If patients initially treated with supportive measures do not improve after seven days or symptoms worsen, then they should be reevaluated and possibly treated for other causes of gastroenteritis.
▪︎درباره نقش Antimotility agents:
Specific symptomatic therapies for adults with acute viral gastroenteritis with moderate to severe non-bloody diarrhea or signs or symptoms of volume depletion who do not have a fever higher than lowe grade.
▪︎نقش antiemeticها:
Although studies in adult populations are lacking, for patients who cannot tolerate oral rehydration due to excessive vomiting, we suggest treating with an antiemetic (eg, prochlorperazine or ondansetron) as needed for one to two days to facilitate oral fluid repletion.
▪︎درباره زینک و پروبیوتیک هم گفته که پروبیوتیک خیلی established نشده. زینک هم طبق WHO توی بچه‌ها میشه داد.
▪︎یه چندتا نکته درباره‌ی اندانسترون هم داشته باشیم:
▫️Dosage: Oral, IV, IM: 4 to 8 mg as a single dose ; may repeat 4 to 8 mg every 4 to 8 hours as needed(max 24mg/day).
▫️Onset of action: 30 min
▫️Peak plasma time: IV, end of infusion; IM, 30 min; PO, 2 hr (tablet) or 1 hr (soluble film)
▫️Half-life: 3-7 hr (adults)
▫️Risk factors for long qt:
• IV route of administration
• Single doses >16 mg IV; however, risk should be considered even with low IV doses.
• Concomitant medications that prolong the QT interval
• Females
• Hypothermia
• Concomitant volatile anesthetics or cumulative high-dose anthracycline therapy
• Underlying heart disease including heart failure or acute coronary syndromes
• Electrolyte abnormalities (eg, hypokalemia, hypomagnesemia)
• History of QT prolongation, bradycardia, tachycardia, or cardiac rhythm disorders (especially ventricular arrhythmia)
• Patients receiving ondansetron following anesthesia, while in the intensive care unit, or during hospital admission
➡️
1. Causes of acute infectious diarrhea and other foodborne illnesses in resource-abundant settings.
2. Acute viral gastroenteritis in adults