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OTHER CAUSES Side effects from medications are probably the most common noninfectious cause of acute diarrhea, and etiology may be suggested by a temporal association between use and symptom onset. Although innumerable medications may produce diarrhea, some of the more frequently incriminated include antibiotics, cardiac antidysrhythmics, antihypertensives, nonsteroidal anti-inflammatory drugs (NSAIDs), certain antidepressants, chemotherapeutic agents, bronchodilators, antacids, and laxatives. Occlusive or nonocclusive ischemic colitis typically occurs in persons 50 years; often presents as acute lower abdominal pain preceding watery, then bloody diarrhea; and generally results in acute inflammatory changes in the sigmoid or left colon while sparing the rectum. . | Chapter 040. Diarrhea and Constipation Part 6 OTHER CAUSES Side effects from medications are probably the most common noninfectious cause of acute diarrhea and etiology may be suggested by a temporal association between use and symptom onset. Although innumerable medications may produce diarrhea some of the more frequently incriminated include antibiotics cardiac antidysrhythmics antihypertensives nonsteroidal anti-inflammatory drugs NSAIDs certain antidepressants chemotherapeutic agents bronchodilators antacids and laxatives. Occlusive or nonocclusive ischemic colitis typically occurs in persons 50 years often presents as acute lower abdominal pain preceding watery then bloody diarrhea and generally results in acute inflammatory changes in the sigmoid or left colon while sparing the rectum. Acute diarrhea may accompany colonic diverticulitis and graft-versus-host disease. Acute diarrhea often associated with systemic compromise can follow ingestion of toxins including organophosphate insecticides amanita and other mushrooms arsenic and preformed environmental toxins in seafood such as ciguatera and scombroid. Conditions causing chronic diarrhea can also be confused with acute diarrhea early in their course. This confusion may occur with inflammatory bowel disease IBD and some of the other inflammatory chronic diarrheas that may have an abrupt rather than insidious onset and exhibit features that mimic infection. APPROACH TO THE PATIENT ACUTE DIARRHEA The decision to evaluate acute diarrhea depends on its severity and duration and on various host factors Fig. 40-2 . Most episodes of acute diarrhea are mild and self-limited and do not justify the cost and potential morbidity of diagnostic or pharmacologic interventions. Indications for evaluation include profuse diarrhea with dehydration grossly bloody stools fever 38.5 C duration 48 h without improvement recent antibiotic use new community outbreaks associated severe abdominal pain in patients 50 years and elderly
