Diarrhoea
Gastrointestinal Conditions
A09.0
See: Gastrointestinal Conditions. Diarrhoea
DESCRIPTION
The commonest cause of diarrhoea in palliative care is laxative use. Other causes include partial intestinal obstruction, HIV-associated diarrhoea, pancreatic insufficiency, Clostridium difficile infection, chemotherapeutics, and radiation enteritis.
Severe constipation and faecal impaction can also cause diarrhoea as backed-up, liquefied stool may be all that the patient can pass (“overflow diarrhoea").
GENERAL MEASURES
Refer to a dietician.
Consider faecal impaction and perform rectal examination if indicated.
MEDICINE TREATMENT
- Rehydrate the patient as appropriate if necessary. See: Diarrhoea, acute in children and Diarrhoea, acute, without blood, in adults.
Adults:
- Loperamide, oral, 4 mg immediately and 2 mg as required after each loose stool up to 6 hourly.
- Not more than 16 mg daily
- Contraindicated in antibiotic-induced diarrhoea and overflow diarrhoea.
REFERRAL
- Persistent diarrhoea (> 2 weeks) in children.
Standard Treatment Guidelines and Essential Medicines List for South Africa, Primary Healthcare, 2020-2024_Version 1.0_07 November 2024
Chapter 22: Medicines Used in Palliative Care_22.1 Gastrointestinal Conditions_22.1.2 Diarrhoea