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Loperamide inappropriate use — GPhC CRA MCQ

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HardGastrointestinal TherapeuticsLoperamide inappropriate useGPhC CRA

Five days after onset of bloody diarrhoea, a 4-year-old becomes pale and lethargic, passes very little urine and develops facial puffiness. A parent asks whether to give loperamide and wait until morning. What is the best advice?

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Correct answer: C — Arrange immediate paediatric assessment for possible haemolytic uraemic syndrome

The sequence of bloody diarrhoea followed by pallor, lethargy, oliguria and oedema is concerning for HUS with microangiopathic haemolysis, thrombocytopenia and acute kidney injury. It needs immediate paediatric assessment and laboratory evaluation. Antimotility treatment, NSAIDs, empiric leftover antibiotics and unsupervised fluid restriction can worsen risk or delay recognition of a medical emergency.

Reference: NICE CG84: gastroenteritis in under-5s. https://www.nice.org.uk/guidance/cg84/chapter/Recommendations NHS Greater Glasgow and Clyde: bloody diarrhoea and HUS. https://clinicalguidelines.scot.nhs.uk/ggc-paediatric-guidelines/ggc-paediatric-guidelines/kidney-diseases/management-and-investigation-of-bloody-diarrhoea-and-haemolytic-uraemic-syndrome/