Understanding and managing chemotherapy-induced diarrhea.

Diarrhea is particularly problematic in patients receiving fluoropyrimidines and/or irinotecan. Careful patient monitoring, patient education, and good patient-provider communication are the primary tools of prevention. The patient must be carefully evaluated on a regular basis early in treatment, so that mid-course corrections, dose adjustments, or dose delays can be instituted early on if indicated. Diet need not be modified as a preventive measure, but once diarrhea occurs, a number of modifications must be made. Maintenance of fluid intake is critical and inability to maintain adequate hydration would be a primary indication for parenteral fluid support. Oral intake of fluids should not be limited to plain water only, since electrolytes need to be replenished. Early recognition of diarrhea and early pharmacologic intervention can greatly facilitate successful resolution of this treatment complication.