TYPES OF DIARRHOEA
There are two types of diarrhea.
1. Acute
2. Chronic
Acute Diarrhea: Diarrhea of sudden onset is very common. It is short-lived (2-5 days) and requires no investigations or treatment. However, the discomfort and inconvenience of frequent and urgent cause to the comfort forces the victim to treatment.
The acute causes of diarrhea are:
· Dietary problems.
· Emotional disturbance.
· Infective
o Food Poisoning
o Viral Gastroenteritis (lasts for 24-48 hours)
· Traveler’s Diarrhea (lasts 2-5)
Causes: For example E.Coli, Shigella. E.histolytica, Giardia lamblia.

CLINICAL FEATURES: The clinical features associated with acute diarrhea are fever, abdominal pain and vomiting. If diarrhea last longer (beyond 2-5 days), there arise need for investigation and dehydration may occur. Oral fluid replacement plays a key role in the treatment of diarrhea. Special ORS Solutions are used. Antidiarrheals are thought to impair the clearance of any pathogens from the bowel but may be necessary for short-term relief.
Chronic Diarrhea:
Causes:
1. Inflammatory bowel disease.
2. Fungal infection
3. Ulcerative colitis
4. Colonic neoplasia
5. Malabsorption
6. Endocrine
a. Pancreatic tumors
b. Thyrotoxicosis
c. Diabetic neuropathy
7. Neurotic disorders
Drugs: Drug induced diarrhea.
1. Fetal impaction in the elderly people.
2. Diarrhea in HIV infection.
Treatment: Although the non-specific drug therapy remains the normal practice clinically. The knowledge of the type or diarrhea may be of great help to physician to decide when to use non-specific and when to use specific antidiarrheal agents. For example the treatment of osmotic diarrhea, first involves removal of the offending osmotic agents or correction of the underline malabsorption process. (For example pancreatic enzyme for pancreatic insufficiency, Gluten free diets for Gluten-sensitive enteropathy). The treatment of infectious diarrhea first involves antimicrobial whereas the treatment of chronic inflammatory disease first involves anti-inflammatory agents, likewise treatment of secretory diarrhea (carcinoid syndrome, VIP secreting tumor and AIDS diarrhea etc) require hormonal therapy.

FLUID AND ELECTROLYTE TREATMENT

Drugs have a place in the management of diarrhea bur the first priority of the therapy is to prevent fluid and electrolyte misbalance. Oral rehydration treatment (ORT) with glucose-electrolyte solution is sufficient enough to treat vast majority of episodes of dehydration. ORT is simple, effective, cheap and readily available therapy for potentially lethal condition. This is effective because glucose-coupled sodium transport continues during diarrhea and provides means of replacing water and electrolyte imbalance. Sometimes it proves to be life saving. WHO/UNICEF recommended ORS is as under.
The quantities of ingredients in grams/solution are as under.
NaCl: 3.5g.
KCl: 1.5g.
Sodium Citrate: 2.9g.
Anhydrous Glucose: 20g.
However, some researchers have developed other formulations by replacing Glucose by other substances like Cereal based ORS, honey based ORS.

NON-SPECIFIC DRUG TREATMENT

There are two types of drugs, which are commonly used to treat acute diarrhea. Most of the drugs increase the viscosity of the fecal contents.
Adsorbents: These are the drugs, which increase the viscosity of blood contents directly. These are the substances, which are not absorbed.
1. Clays.
a. Activated Attapulgite.
2. Charcoal.
3. Synthetic resin-calcium polycarbophil.
These agents consist of finely divided particles, which have adsorbent properties due to high surface area. They are thought to act by adsorbing toxins, which are responsible for diarrhea, and also they provide a coating for the intestine. Furthermore, they improve the consistency of feces. By all these actions the contents stay for relatively higher period in the intestine and the reabsorption of water occurs, that further improves the diarrheal condition.