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Diarrhea
July 16, 2012 by Dr. Mandar V. Bichu
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Diarrhea

Do you know how the word ‘diarrhea’ was originated? It comes from amalgamation of two Greek words- ‘Dia’ meaning ‘through’ and ‘rhien’ meaning ‘flow. Medically it denotes an increased frequency of loose, altered, abnormal stools and is called -‘Gastroenteritis’.

Acute and chronic types of diarrhea are primarily differentiated by the duration. Acute variety lasting less than 2 weeks and chronic one persists more than 2 weeks. The causes, course and treatment of two types differ a lot.

 

What are the causes of acute diarrhea?

Practically all cases of acute diarrhea are caused by infections of gastrointestinal tract. These infections can be viral, bacterial or parasitic in nature.

Viruses (rotavius, Norwalk virus and adenovirus); bacteria (E.coli, samonella, shigella, V.cholerae and campylobacter) and parasites (Entamoeba histolytica, giardia and cryptosporidium) are the main pathogens. These infective organisms cause diarrhea either by direct invasion or by causing inflammation of intestines or through the effect of toxins they release.

These infections are transmitted through fecal-oral route, i.e. through stool- contaminated water and food.

 

How do we differentiate between viral and bacterial diarrhea?

Oversimplifying this often confusing distinction, I would say that profuse, painless, watery diarrhea with minimal systemic symptoms is more likely to have a viral origin and scanty, frequent, painful diarrhea with severe systemic symptoms like fever is more likely to be bacterial. Bloody diarrhea or dysentery is more likely to be bacterial in origin. Viral diarrhea is more likely in winter and bacterial type is seen more commonly in summer.

 

What is food poisoning?

This is a peculiar entity of diarrhea occurring within a short period after consuming food items contaminated with certain microorganisms or their toxins. Salmonella (through dairy/ meat products and eggs), Staphyllococci (through meat, eggs, pastries or salads), Clostridum perfringens (through meat and gravy) and Clostridum botulinum (through canned food, honey and fish) are the major offenders.

Food poisoning is usually suspected when a group of people eating the same food suffer from gastrointestinal symptoms within few hours of the ingestion.

 

What is dehydration?

Dehydration means loss of body water. Up to 5% water loss means mild dehydration; up to 10% means moderate and over 15% means severe dehydration. Mild degree of dehydration is manifested just as lethargy, thirst and irritability. Moderate dehydration, in addition, leads to depressed fontanelles, sunken eyes, dry mouth and lips, absent tears, decreased skin elasticity, rapid pulse, reduced urine output and sometimes drowsiness. In severe dehydration, all these signs are exaggerated and patient goes into shock and even coma.

Dehydration with electrolyte imbalance and acidosis (because of loss of bicarbonates in stools) are the main dangers of diarrhea.

 

What is ORS?

It is a short form for Oral rehydration solution. It is a scientifically proven and simple way of providing fluids and correcting electrolyte imbalance in situations like diarrhea and vomiting. It is available free in government hospitals and commercial preparations based on same principles are also available in pharmacies. Most cases of mild and moderate dehydration can be adequately handled even at home by using ORS under medical guidance.

The current WHO/UNICEF- recommended ORS composition is as follows:

 

Content

Quantity

1.

Sodium chloride

2.6 gm

2.

Tri-sodium citrate

2.9 gm

3.

Potasssium chloride

1.5 gm

4.

Glucose

13.5 gm

5.

Water

1 liter

 

Is there a home remedy alternative to the ORS?

Practically a salt-sugar solution in the following proportion serves the purpose of Home ORS in most cases of uncomplicated diarrhea.

 

Content

Quantity

1.

Salt

2.5 gm (1/2 teaspoonful)

2.

Sugar

30 gm (6 teaspoonful)

3.

Water

1 liter (5 cups)

*Note – The teaspoon measurement should be with content at a flat level in the teaspoon and not as a heaped measure.

 

Are Zinc supplements useful in diarrhea?

Zinc supplements along with ORS have been shown to be effective in reducing the duration and severity of diarrhea; reducing the need for hospitalization; reducing the chances of later pneumonias and reducing mortality.

The supplements should be given for 10-14 days.

The recommended doses for Zinc are:

For infants less than 6 months: 10 mg/day

From 6 months – 5 years: 20 mg/day

 

When are intravenous fluids necessary?

IV fluids are only necessary in conditions like severe dehydration, shock, persistent vomiting, refusal to accept oral rehydration, very large and frequent stools, extreme fatigue, severe abdominal distension, altered mental state or other significant complications.

 

When are lab tests necessary?

As a routine case of acute diarrhea is mostly self-limiting and requires only precautions regarding food and fluids, no particular lab test is necessary there. Only in cases of bloody diarrhea, severe associated systemic symptoms, significant dehydration or persistent diarrhea, stool and blood need to be tested in lab to get to the root of the problem.

 

What should be the diet in diarrhea?

The main thing to understand is that the food shouldn’t be denied to a diarrhea patient but it should be modified.

Too starchy, too fatty or too sugary foods and non-vegetarian foods (meat, poultry, fish and egg) should be preferably avoided. Sugared fruit juices, fizzy cola drinks and even plain water alone are not the ideal fluids for replacement and may worsen the situation by causing electrolyte imbalance.

In my practice, I advise following items in diet:

·         Rice-kanjee or rice-water with salt (Improves absorption of electrolytes, provides fluids and electrolytes)

·         Clear vegetable or chicken-broth with salt (Provides fluids and electrolytes)

·         Yoghurt or butter-milk with salt (Provides lactobacillus, a useful type of bacteria which will displace the harmful ones)

·         Darkly toasted bread (Kaolin or carbon from darkened toast adsorbs the toxins.)

·         Sliced or mashed semi-ripe fruits like banana, apple or pear. (Provide Potassium. Pectin from these fruits helps in binding the stools.)

·         Un-sugared fruit-juices (like apple or orange juice) can be offered in small quantities.

What should be done in infants and toddlers on milk-feeds, who are having diarrhea?

The breast-feeding should be continued as it i

  In formula-fed babies, either a diluted milk formula or a lactose-free milk formula should be offered.

·              Cow’s milk should be preferably avoided or offered in small quantity in dilute form.

 

What is the role of medicines in diarrhea?

The unfortunate tendency of parents is to demand medicines and that of unscrupulous medical practitioners to supply a prescription full of them has seen to it that a number of unnecessary medicines being used routinely in cases of diarrhea. The most commonly used medicines in this situation are anti-motility agents like loperamide, anti-spasmodics, anti-secretory agents like bismuth preparations, stool binders like kaolin-pectin and lactobacillus preparations. None of these medicines has any significant role to play in majority of acute diarrhea cases.

 

The main thing to know is that using the medicines to reduce the frequency or improve the consistency of stools is not only unnecessary but could even prove dangerous due to unwanted side-effects of these medicines. Formed stools after using such medicines could still carry high water-load and just give a false sense of security and delay in requisite fluid replacement.

Antibiotics (like cotrimoxazole, nitrofurantoin, ciprofloxacin and norfloxacin) and anti-parasitic medicines (like metronidazole) are also often used quite recklessly and it would be prudent to ask the doctor why he considers them necessary. Even in bacterial diarrheas, antibiotics are seldom required and in many instances, their use prolongs the diarrhea more.

 

What are the preventive measures against diarrhea?

Ø  Breast feeding (in infancy),

Ø  Hand-washing with soap and water after toilet and before food.

Ø  Using clean drinking water.

Ø  Avoiding outside food.

Ø  Proper cleaning and washing of food like meat and vegetables

Ø  Eating freshly prepared and properly cooked food 


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Right Parenting.Com is a site dedicated to offer compassionate scientific guidance on various parenting and child-health issues. It is managed by Dr. Mandar V. Bichu, a Sharjah-based paediatrician with the help of experts in various fields.
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