Brainerd Diarrhea Treatment 

Symptomatic Medications and Measures: 

• Fluid replacement  is an important component  of treatment, especially in patients with significant dehydration where it is often the most important component. 
• Oral replacement with oral rehydration solutions (ORS); commercially available packets include Cera Lyte generic ORS, the WHO ORS, Rehydralyte, Pedialyte, Resol,  and Rice-Lyte. 
• IV replacement with 0.9% NS with 20 mEq KCL  or with Lactated Ringers solution should be used in  patients with moderate to severe diarrhea or  in patients not tolerating oral replacement. 
• Antimotility agents, such as loperamide 4 mg po, then 2 mg po post each loose stool to a maximum of 16 mg/day are of benefit; avoid  with C. difficile diarrhea, enterohemorrhagic E. coli diarrhea. 
• Diphenoxylate with atropine and tincture  of opium offer no major advantage over loperamide; all of these agents should be avoided in patients with dysentery and/or EHEC infection (may result in HUS)  as well as C. difficile diarrhea. 
• Other recommendations: lactose-free (e.g. milk, cheese) diet, caffeine avoidance, Metamucil, bismuth subsalicylate, Kaolin-containing agents,  and probiotics. 
• Gatorade, fruit juices, and soft drinks are hyperosmolar and deficient in electrolytes and thus are sub-optimal replacements for patients with significant dehydration. 
• These drinks may be sufficient in otherwise healthy patients who are mildly ill; additional electrolytes from soups or saltine crackers will be supplemental.