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10- Diarrhea - Abnormal Stools


Attention: Serious danger of dehydration!!!  See "8-Dehydration"

First step

Fever?  Blood?  Flatulence?

1-Mild without fever

Oral Rehydration Solution or Coca-Cola (not loperamide!!!)

2-Without fever

"Non-absorbable antibiotic"(Coccila, Ercefuryl…) 1-2tab 4x/day

3-With fever

Norfloxacin 200mg 1tab 2x/day.  If not better then metronidazole400mg 1tab 3x/day (+/- loperamide)

4-With blood

Ciprofloxacin 500mg 3x/day.  If not better, then metronidazole400mg 3x/d

5-With flatulence

Metronidazole 400mg 3x/day (Giardiosis?)  (+/- loperamide)

6-Anemic... worms?

Mebendazole 100mg 6x1 one day or 1x2 3days

7-Lymph node in abdomen + TB signs...

TB? MAC? See "protocol TB"

8-Nothing is working?

Albendazole 200mg 2tabs 2x/day (microsporidias?)  (+/- loperamide)

9-Still nothing is working...

Bactrim 2x4 (Isospora belli?...)

10-Still nothing is working...

Loperamide 1-4tabs 4x/day


If possible, before ordering any drugs confirm the accuracy of your choice by a second step in the analysis:


Second step: try to look at stool/diaper...

...And change your decision if you feel it is necessary (you can never be sure that fever is connected with diarrhea; and patients often do not accurately describe rectorrhagia or smells...)

8- Mucus

(sfx009)  (sfx019)  (sfx020)  (sfx007)  (sfx014)  (sfx021)  (sfx005) (sfx002)  (sfx025)

Mucus means that colon pathology is involved.  Absence of mucus means supracolonic or anal problem.  Only mucus often means parasites...  If you are unsure, try metronidazole, mebendazole...

9- "Cow dung"


Think about Giardiosis first, especially if severe aerophagy...  Treat with metronidazole even if neither fever nor blood.

10- Red blood (mixed in stool)

(sfx006)  (sfx015)

Lesions are probably high in colon...  Try metronidazole even if patient has no fever.  Think also about worms.

11- Red blood (not mixed into stool)

Without mucus


If no mucus, can be hemorrhoids or an anal fissure, or rectal polyps...  ("4-Anal Area") But if there is "bloody mucus" (like a red sauce) on the stool, the cause is probably a "lesion" higher in the colon and you should try metronidazole.  Consider also worm diagnosis.

With mucus

(sfx007)  (sfx014)

12- "Black tar"

(sfx008)  (sfx026)

Melena?  (Has a typical bad smell).  Often patients need a gastric treatment more than an antibiotic (see "21-Stomachache")...  We can also suspect hemostatic problems...  (See "16-Hemorrhagia").  Common in last step of long & difficult agony... just before die...

13- "Black stools"

(sfx017)  (sfx018)

Mild melena?  Not all black stools are melena...  (Smell)  Darkness can also come from the iron in anti-anemic drugs or from a rich protein diet...

14- "Green stools"


I still wait for professional advice...  Now, even if no fever is present, I prefer to start immediately with metronidazole...

15- Aqueous diarrhea

Not homogeneous stool


I am still waiting for good advice to help me make a clear distinction between "homogeneous" and "not homogeneous" aqueous stools.

If "only" aqueous diarrhea, good hydration must be the first goal...  Often a virus is the cause and antibiotics are useless.  Try albendazole if nothing else works... and loperamide only if albendazole is also ineffective.

Homogeneous stool

(scx011)  (scx016)

16- "White stools"


Think about hepatic failure, especially if urine is dark and icterus also present.  Viral cause?  Adverse drug effect (common with AIDS patients)?  Biliary obstruction?...

17- Visible worms...

(scx029...) Mebendazole...



- Loperamide should always be used with an antibiotic except in situation 7 above.

- Pepsi always worth trying (should be opened some time before drinking so that the gas dissipates).  If unable to drink anything, IV fluids (NSS+D5%W+NSS+D5%W+…  See 8-Dehydration)

- Many kinds of parasites can cause diarrhea, rectorrhagia, mucus and tenesmus...  Not only Giardia and amoeba but also hookworms, ascaris, etc.  Mebendazole is always worth trying (1tab 2x/day for 3days or 6tabs one day)...  And because patients are often from poor social/hygiene backgrounds, we do not necessarily have to wait for diarrhea or clear symptoms of worm infection in order to treat!






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paul yves wery - aidspreventionpro@gmail.com

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