The Poopy Pants Episode

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We explore the clinical management of foodborne and waterborne illnesses, focusing on key differences between viral and bacterial causes that determine treatment approaches. Understanding when to use supportive care versus antimicrobial therapy helps clinicians provide appropriate management for this common presentation.

• The vast majority of diarrheal illnesses are viral, self-limited, and need no testing or treatment beyond oral rehydration
• Oral rehydration solutions are preferred over sports drinks, which can worsen diarrhea unless diluted
• Homemade solution can be made with half teaspoon salt, six teaspoons sugar, and one liter of water
• Anti-motility agents like loperamide should be avoided in children under two and patients with bloody diarrhea
• Bloody diarrhea with fever (dysentery syndrome) typically indicates bacterial causes like Salmonella, Shigella, E. coli O157:H7, or Campylobacter
• Azithromycin is now preferred over fluoroquinolones for treating bacterial diarrhea due to less resistance
• Antimicrobials should be avoided in children with suspected E. coli O157:H7 due to risk of hemolytic uremic syndrome

Watch for more detailed content on managing diarrheal illnesses in high-risk groups coming soon to the pit.

Chapters

• 0:04 Introduction to Foodborne Illnesses
• 0:43 Viral Diarrhea Management
• 1:38 Oral Rehydration Techniques
• 2:21 Bloody Diarrhea Treatment Approaches
• 5:13 Teaser for Future Content

Transcript

Speaker 1: 0:04

Hey, invictus people, let us this time do some foodborne, waterborne illness stuff. The bloody poops, the non-bloody poops, they love it. On tests, it's obviously a very common ER urgent care presentation. So let's just do some broad strokes and then in coming weeks we'll get into this in some detail. But they really like to examine on this. So I'm getting a lot of my information here out of the Corpendium Now in Corpendium it's electronic, it's on your phone, it's on your computer, but I'm just a guy that likes to, when I'm reading, to have a piece of paper. I'm old school so you'll see me do this. So here are some of the broad strokes themes.

Speaker 1: 0:43

When it comes to diarrhea, first of all, the most important thing is that the vast majority of diarrheal illnesses getting the poopies is viral, self-limited, no treatment, no testing needed, and that will come up on the exam. So it'll be a young person who's got some poopy but there's no blood, they're not immune, suppressed, and what do you do with this person? And the key thing for that person is to basically do supportive care. If they've got a bit of a fever, treat the fever. And then it's all about hydration and the key thing with the hydration is that it is oral rehydration. You do not need to slap in an IV, you don't need to send electrolytes, you don't need to do anything for these routine cases that come in. You can basically orally rehydrate. How do you do that? One of the answers might be something like Pedialyte rehydration solution or some other version of that. That is actually a trade name, I believe. So a rehydration solution? Fine, they don't want you to use Gatorade and sports drinks because they have too much electrolyte, too much glucose most of the time, which can actually make the diarrhea worse.

Speaker 1: 1:49

In the real world. You can use them, but you need to dilute them a lot like to about a quarter of that. You can make up your own treatment, and that own treatment is one moment please, as I look it up, because I believe it is half a teaspoon of salt, six teaspoons of sugar into one liter of fluid. But we're going to look at that. Yes, that's right, it is half a teaspoon of salt, six teaspoons of sugar and one liter of water. Okay, you can also give them anti-nausea agents like Endancitron. That's fine.

Speaker 1: 2:18

Now let's talk about whether you should give them anti-motility agents. Stop them pooping in their pants. Yes, you can do that. The classic one is loperamide. They do not like loperamide in kids under the age of two and in general they don't like to use loperamide, these antimotility agents or simethicone or other stuff as well. But in the real world, you know, you're probably going to use them, but not in the little kids.

Speaker 1: 2:41

Now we don't want to use antimotility agents in patients who have bloody diarrhea, that sort of bacillary dysentery-like syndrome, high fever, bloody poops. Generally you don't want to use antimotility agents. But this is very, very controversial and on the exams it's not sure if they'll do that, because it turns out that if you're giving antimicrobials to somebody with that bloody dysentery syndrome, you probably can give antimotility agents and they do fine. The other big thing that there is fairly much consistency on the exam is don't give antimicrobials to kids. This generally is associated with an increased production of the sugar toxin which can make them develop the complications, things like hemolytic uremic syndrome. So you want to avoid antibiotics in kids, but the vast majority let me go back and say this again the vast majority is self-limited. It's non-bloody, it's viral and they just get better on their own. You don't need to do any testing, you don't need to do much of anything except to rehydrate them. We talked about the rehydration solutions.

Speaker 1: 3:42

Now, if they're giving you a case of a patient with bloody diarrhea, classically the bloody diarrhea will also be associated with fever. This is the dysentery-like syndrome, bacillary dysentery. This is often caused by bacteria. The classic ones are salmonella, shigella, e coli, 0157h7, and what's the other one? Campylobacter. So these you can actually treat with antimicrobials. This does appear to reduce the duration of symptoms.

Speaker 1: 4:09

These can have significant complications, particularly in the very young, the very old, the immune suppressed. In that case antimicrobials is fine Generally. The new thing that's changed over the last few years is we start with azithromycin, not with fluoroquinolones. The fluoroquinolones are associated with a lot of side effects but also with a significant amount of resistance. So that's sort of for me sort of the new thing as an old guy.

Speaker 1: 4:34

And in those circumstances if you're giving antimicrobials, I don't think they're going to ding you for using something like an antimotility agent as well. But just know, in kids they really do not like antimotility agents and they really do not like to give antimicrobials. But if the kid is sick high fevers, it's been going for a while then culture the poopy and then give antimicrobials is probably the right thing to do? We'll talk about pregnancy and other stuff later. I think that's enough for now. Is that a broad enough overview to begin? And then what we'll do is we'll dive into some more specifics later and then sort of the high-risk groups like pregnancy and other ones. All right, herbert out. Oh, I should say that we are working really hard. We've got lots of faculty and it's going to be pretty good. We are pushing this, trying to get it out in late summer. I don't know if we'll get there, but it's all happening and you better be watching the pit because it's awesome. Herbert out.