Octreotide is a long-acting somatostatin analog. It is useful in the treatment of diarrhea associated with intestinal endocrine tumors (e.g. carcinoid, vasoactive intestinal peptide) (Kvolsefa/ 1986) and in patients with diarrhea associated with AIDS. A starting dose of 50 pg subcutaneously daily may be increased to 100 pg three to four times daily to control symptoms. Side-effects include transient nausea, bloating, and hyperglycemia.

There is no information on its effect on diarrhea associated with critical illness. Bismuth subsalicylate

Bismuth subsalicylate is available as Pepto-Bismol (Procter and Gamble, United States, Canada, United Kingdom). The salicylate dissociates in acid pH in the stomach and is absorbed, leaving 99 per cent of the bismuth to pass through the bowel unabsorbed. Bismuth has some antimicrobial activity, although the significance in diarrhea is uncertain, and it may have antisecretory effects.

Non-absorbed bismuth turns the stools black and absorbed bismuth can cause encephalopathy. Bismuth compounds should not be used in patients with impaired renal function.

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