5. Oral rehydration therapy (ORT). In diarrhoea, large volumes of water are lost and sodium and potassium alkaline salts are excreted along with it, leading to a fall in plasma pH (acidosis), which can have serious metabolic consequences. Fluid and electrolyte losses are increased if vomiting also occurs. Oral rehydration salts are not intended to relieve symptoms but designed to replace water and electrolytes lost through diarrhoea and vomiting. They contain sodium and potassium to replace these essential ions and citrate and/or bicarbonate to correct acidosis. Glucose is also included as a carrier for the transport of sodium ions, and hence water, across the mucosa of the small intestine, as well as providing the energy necessary for the process. ORT is probably the only alternative treatment to loperamide that you could recommend. 

€¢ Adsorbents (kaolin, bismuth subsalicylate). The rationale for their use is that they are capable of adsorbing microbial toxins and microorganisms onto their surfaces. Because these substances are not absorbed from the gastrointestinal tract, the toxins and microorganisms are thereby excreted in the stool. The lack of absorption also means that adsorbents are relatively harmless and safe to use. But there is little evidence that they are effective. In addition, adsorption is a non-specific process and, as well as adsorbing toxins, bacteria and water, adsorbents may interfere with the absorption of other drugs from the intestine. This should be borne in mind if recommending adsorbent antidiarrhoeals to patients taking other medicines. Bismuth subsalicylate is claimed to possess adsorbent properties, and some studies have shown it to be effective in treating diarrhoea. However, large doses are required and salicylate absorption may occur, and it should be avoided by individuals sensitive to aspirin.

€¢ Morphine. Morphine acts promptly on the intestine, but it is not well absorbed orally and its content in diarrhoea preparations may in any case be sub-therapeutic. It is available OTC as a liquid containing 1mg in 5ml.

€¢ Kaolin and Morphine Mixture BP. This contains less than 1mg morphine per 10ml dose. Also, the availability of morphine in this preparation may be reduced due to its adsorption onto the kaolin. It is flagged in the BNF as 'less suitable for prescribing'.