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258   Diarrhea, Acute


           •  Mucous membrane color           •  Inflammatory (e.g., enteritis, pancreatitis)  subsalicylate  0.1-1 mg/kg  PO  q  8-12h.
            ○   Brick  red/injected:  sepsis,  hemorrhagic   •  Toxins/medications  Neither is recommended in cats (decreased
  VetBooks.ir  ○   Pallor: hypoperfusion/shock/pain versus   Initial Database    •  Motility  modifiers  (e.g.,  loperamide
                                                                                   ability to metabolize salicylates).
              gastroenteritis (p. 259)
                                              Fecal examinations: typically, a minimum of
              anemia (gastrointestinal [GI] blood loss)
                                                                                   0.1-0.2 mg/kg PO q 8-12h) may be con-
           •  Dehydration (caveat: nauseated animal may
            have moist mucous membranes despite   three samples or until a positive result is found  sidered only for intractable diarrhea and if
                                                                                   an infectious cause has been excluded. Use
                                              •  Cytology (fresh saline smears)
            dehydration)                      •  Flotation                         judiciously and for no longer than 3 days.
           •  Signs of shock/sepsis (e.g., fever, tachycardia   •  Parasite antigen test (more sensitive)
            [cats: bradycardia more common], tachypnea,                          Drug Interactions
            cool extremities [variable])      Advanced or Confirmatory Testing   Anticholinergics are contraindicated  with
           •  Posture  as  sign  of  abdominal  pain:  “dog-  •  As dictated by clinical suspicion  obstruction and/or sepsis.
            praying” position/arched back     •  Consider CBC, serum biochemical profile,
           •  Abdominal palpation ±             urinalysis, infectious disease testing, especially   Possible Complications
            ○   Evidence of pain                if depressed, dehydrated, or febrile (e.g.,   •  Dehydration
            ○   Thickened,  fluid  or  gas-filled  bowel   canine parvoviral antigen ELISA).  •  Sepsis/endotoxemia
              (inflammation, neoplasia)       •  Abdominal radiographs, ± contrast radiog-  •  Development  of  intussusception/other
            ○   Mass effect (obstruction, foreign body)  raphy, and/or ultrasonography if obstruction   intestinal accident
            ○   Lymphadenomegaly  (neoplasia,  inflam-  or mass lesion suspected
              mation, infection)                                                  PROGNOSIS & OUTCOME
            ○   Urinary bladder size (with respect to    TREATMENT
              hydration status and renal function)                               •  Dietary  indiscretion:  often  benign  and
           •  Perineum: external erythema     Treatment Overview                   self-resolving
           •  Rectal palpation: perineal hernia, anal sac   •  Many cases of acute diarrhea in otherwise   •  Parasitic  diseases:  generally  good,  barring
            disorders, and perianal fistulas may mimic   normal dogs and cats are transient and   obstruction
            signs  of  LI  disease  (e.g.,  pain,  tenesmus,   self-resolving.   •  Infectious, endocrine causes, intoxications,
            hematochezia).                    •  Palliative treatment for comfort (e.g., antidi-  mechanical obstruction and hemorrhagic
           •  Observe  animal  defecating  (tenesmus,   arrheal medications, bland diet, probiotics)   gastroenteritis: potentially life-threatening
            dyschezia, character of feces)      is often a good option for benign acute
                                                diarrhea caused by spontaneous or temporary    PEARLS & CONSIDERATIONS
           Etiology and Pathophysiology         disorders, such as dietary indiscretion.
           •  Abnormal transmucosal movement of water   •  Acute diarrhea can be instigated by disorders   Comments
            and solute                          that will not resolve spontaneously or are   Do not use antibiotics indiscriminately; alters
            ○   Osmotic (decreased solute absorption),   contagious/zoonotic.  For  these,  the  cause   microbiome, promotes bacterial resistance
              secretory (hypersecretion of ions), exuda-  must be identified and addressed.
              tive (increased permeability),  abnormal   •  Additional diagnostic testing and treatment   Technician Tips
              motility                          are warranted if the patient is markedly ill,   Proper hygiene vital: avoids contagion/zoonoses
           •  More than one mechanism possible, depend-  there is failure to respond to empirical treat-  (handwashing between patients, gloves when
            ing on underlying cause             ment within 24-48 hours, or the patient’s   cleaning patients with diarrhea, avoid human
                                                condition deteriorates.          food in clinic areas, strict isolation for suspected
            DIAGNOSIS                         •  Acute diarrhea may lead to volume deple-  infection such as parvovirus)
                                                tion that requires parenteral fluid therapy:
           Diagnostic Overview                  maintenance ± dehydration ± ongoing loss   Client Education
           The extensive list of causes can be narrowed   (pp. 259 and 760).     •  Feeding raw diets is discouraged.
           substantially based on a thorough history and   •  It is important to have an established hospital   •  Proper hygiene is essential (especially with
           examination. Fecal examinations (fresh sample)   protocol to prevent infectious transmission   raw diets): frequent handwashing, regular
           are indicated in all cases. A large proportion of   to other patients or hospital personnel when   cleaning of food bowls/bedding/litter boxes
           acute diarrhea cases are self-resolving and do not   dealing with pets with diarrhea.
           warrant further testing. Additional diagnostics                       SUGGESTED READING
           are indicated if the patient is systemically ill, a   Acute General Treatment  Marks SL: Diarrhea. In Washabau RJ, et al, editors:
           zoonotic concern exists, the history or physical   •  A bland, easily digestible diet; anthelmintic   Canine and feline gastroenterology, St. Louis, 2013,
           exam suggests a nontransient cause, or recurrent   treatment  (if parasites  are suspected  or   Saunders, pp 99-108.
           or prolonged episodes occur.         identified); and/or probiotics are common   AUTHOR: Lisa Carioto, DVM, DVSc, DACVIM
                                                first-line, general treatments for mild acute
           Differential Diagnosis               diarrhea. The author has had good luck using   EDITOR: Leah A. Cohn, DVM, PhD, DACVIM
           See Diarrhea, Section 3 (p. 1213) for detailed   adsorbents (e.g., zeolite compounds).
           differential diagnoses.            •  Antidiarrheal  drugs  may  be  considered  as
           •  Dietary (e.g., new food, dietary indiscretion)  nonspecific  treatment  for  24-48  hours  in
           •  Infectious  (viral,  bacterial,  parasitic;  less   animals  that are systemically  well: kaolin
            often, fungal, algal)               and pectin 1-2 mL/kg PO q 8-12h; bismuth











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