C diff.

I read about C.diff and pseudomembrane colitis now that I'm done with my nutrition section stint. C. diff is a common infection we see in the hospital and often follows antibiotic treatment. It is diagnosed by the presence of diarrhea along with either a positive toxin test or pseudomembrane colitis seen on endoscopy. Treatment is usually with vanc 125mg q6hx10days or metronidazole 500mg TID x 10days(preferably PO) both of which can cause C. diff themselves. Vanc is for more seriously ill patients esp ones with a white count higher than 15. Resolution of diarrhea occurs in 2-4 days but cannot be called a treatment failure until about 6 days. Unfortunately there is a high recurrence rate. One of my coworkers was questioned about this when we were on GI and that is usally a result of reinfection, recurrence of the same strain, or some effect that the treating antibiotic had on the natural flora.

So I forgot to mention some other thing about anorexia from yesterday that I thought were interesting. There are a lot of electrolyte abnormalities in anorexia and not so much in bulemia since bulemics usually get some sort of nutrition. Anorexics tend to have:
-hyppthalamic amenorrhea
-decreased leptin levels (and leptin makes you full so you think they would by hungry!)
-increased cortisol and 24hour urine free cortisol
-TFTs like a euthyroid sick pt (normal/elevated T4 and free T4, decreased T3, and increased rT3)
- increased GH but decreased IGF

They also have a tendency to develop prolonged QT intervals