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Symptoms of Diarrhoea-
Frequent loose watery stool
Urgent need of bowel evacuation
Stools are uncontrollable
Dehydration- Volume of urine decreases, infrequent urine, sunken eyes, dry mouth, always thirsty or inability to drink due to severe lethargy.
Sometimes vomiting, abdominal pain, fever, tiredness, feeling of lightheadedness, dizziness, muscle cramp, increased heart rate.
Decreased responsiveness and unconsciousness in severe cases.
In case of infants sunken fontanelle ( a diamond shaped soft spot on the top of head), irritability, absence of tears while crying.
Convulsions and unconsciousness may occur.
How to prevent diarrhoea-
Stop open defecation,
Wash your hands after using the toilet. It can prevent 40% diarrhoea.
Wash your hands before and after eating.
Use shoe in the toilet
Wash your hands after touching animals and their wastes
Don’t let your child put fingers, toys or other potentially contaminated items in their mouth.
Safe food habits-
Keep uncooked meat away from other foods
Stock perishable foods in the refrigerator or freezer using a suitable container.
Clean countertops and kitchen utensils, wash every surface that will come in contact with foods
Cook meat thoroughly
Never eat uncooked eggs or uncooked egg products
Use food cover mesh net
Avoid unpasteurized milk and milk products.
Wash fruits and vegetables before eating or cooking.
Avoid food and fruit juice sold by street vendors
Safe water supply and sanitation shows 22-27 % reduction in disease and 21- 30 % reduction in mortality rate associated with diarrhoeal diseases.
Use a water purifier if possible because it can filter physical suspended impurities such as iron rusts, heavy metals such as lead and arsenic.
Water can be purified by using different chlorine compounds.
Where these facilities are not available water may be boiled and cooled before drinking it.
Take probiotics when using antibiotics for a prolonged period.
Take prophylactic antibiotics to prevent travellers Diarrhoea.
Wear clean garments.
Keep your home and surrounding areas clean.
In case of infants and children- Exclusive breastfeeding upto 6 months, Avoid feeding bottle and use cup and spoon, Immunize with measles and rotavirus vaccine, Vitamin A and Zinc supplementation.
In case of diarrhoea in a formula feed baby change the formula and try another one.
Change diapers of a baby as soon as it is wet.
Treatment of Diarrhoea-
A) Rehydration therapy
B) Appropriate feeding
C) Drugs
D) Treatment of associated symptoms
Before starting treatment of Diarrhoea one must assess the severity of dehydration. Gradation of dehydration may be i) No dehydration ii) Some dehydration and iii) Severe dehydration.
No dehydration-
Patient’s appearance- normal
Tongue- moist
Eyes- normal, tears present in baby’s eyes while crying
Urine flow- normal
Skin elasticity- when performing a pinch test skin goes back to its normal position immediately.
Radial pulse- normal rate and volume
Blood pressure- normal.
Some dehydration-
Patient’s appearance- thirsty. Babies may be restless and irritable
Tongue- sticky
Eyes- slightly sunken, less tears in baby’s eyes while crying
Urine flow- infrequent, volume reduced
Skin elasticity- when performing a pinch test, skin goes back to its normal position slowly
Radial pulse- normal rate
Severe dehydration-
Patient’s appearance- drowsy, lethargic, cold extremities ( when diarrhoea is not associated with fever ), unable to drink or drink poorly. Maybe comatose, sweaty.
Tongue- dry
Eyes- marked sunken, no tears in baby’s eyes while crying
Urine flow- little or none
Skin elasticity- when performing a pinch test skin goes back to its normal position very slowly
Radial pulse- rapid, feeble and sometimes impalpable
Blood pressure- low sometimes systolic pressure less than 80 or may be unrecordable.
Estimated fluid loss in case of some dehydration is 40-50 ml/kg body weight
Estimated fluid loss in case of severe dehydration is 100-110 ml/kg body weight
A) Rehydration therapy-
Diarrhoeal stool contains sodium, potassium, chloride and bicarbonate. As a result there is fluid and electrolyte deficit and imbalance and there may be acute renal shutdown. So in diarrhoea fluid and electrolytes should be replaced without delay. Fluid and electrolytes can be replaced by ORS and/or intravenous fluid.
ORS should be given in acute diarrhoea due to any cause and in all age groups. In case of adults it can be given as much as the patient can drink. ( A rough guide is 75 ml/kg in 4 hours where intravenous fluid is not given ).
Intravenous fluid is given in the following conditions-
Severe Diarrhoea
Persistent vomiting
Patient can not take ORS orally due to some reason.
Ringer lactate is used in diarrhoea as intravenous fluid. Injection Normal saline is used when ringer lactate is not available. It should be replaced by ringer lactate when available.
Rough guide of intravenous fluid-
Start 30 ml/kg in half hours. Then 70 mg/kg in the next two and half hours ( In infants less than 12 months 30 ml/kg in one hour. Then 70mg/kg in the next five hours ).
Assess the patient after 30 minutes to 1 hour (level of consciousness, pinch test, ability to drink ), if not improved speed of intravenous fluid may be increased. After giving total 100 ml/kg intravenous fluid reassess the patient, if not improved then repeat this treatment.
If improved to no dehydration or some dehydration and vomiting stops then ORS can be given as maintenance fluid.
Rough guide of ORS-
One stool every 2 hours or more – 5 ml/kg body weight/hour
More than one stool every 2 hours – 15 ml/kg body weight/hour.
If ORS is not available then give home made ORS until ORS is available.
B) Appropriate feeding-
Proper feeding should be continued because a significant amount of nutrients are lost in Diarrhoea. Feeding helps early recovery.
Early digestible foods are plain rice, boiled potatoes, bananas, toasts, crackers and cooked carrots.
Drinks may be given- ORS, plain water, fresh fruit juice without sugar, weak tea without sugar, coconut water, stewed apple, yogurt, rice water.
Foods to avoid- high fat greasy foods, sweet foods such as cakes and cookies, foods that are not easily digestible, spicy foods, high fibre foods, fried foods containing much oil.
Drinks to be avoided- soft drinks, tea containing sugar, drinks containing caffeine, packed fruit juice that contains sugar.
C) Drugs-
Antimicrobial therapy-
Most acute Diarrhoea are self limiting, so antimicrobial therapy is not always necessary.
In some situations such as dysentery, cholera, no improvement or progressive deteriorating condition even after 48 hours of treatment, stool containing excessive amounts of blood, immunocompromised patients, elderly patients age 70 years or more, debilitated patients, patients with valvular vascular or orthopaedic prosthesis, antimicrobial therapy can be given.
Drugs usually used are Ciprofloxacin, ampicillin, Amoxicillin, metronidazole, Azithromycin, cefixime or rifaximin.
Pre and probiotics-
Probiotics such as lactobacillus can shorten the duration of illness in acute diarrhoea and benefit antibiotic associated diarrhoea.
Racecadotril can help by increasing intestinal fluid absorption and reducing stool volume and frequency.
Loperamide is an antimotility drug that increases intestinal transit time thereby increasing reabsorption of fluid and electrolytes. This medicine should not be used below 2 years of age, there may be cardiac, respiratory and CNS side effects.
D) Treatment of associated symptoms
Vomiting- in case of persistent vomiting antiemetic drugs are used.Â
Fever- paracetamol 15 mg/kg body weight, in adults 500- 650 mg/ dose.
Abdominal distension- abdominal distension may be a feature of hypokalemia ( low potassium level in blood). So in that situation a blood test to be done to estimate serum potassium level and oral or intravenous potassium to be given by a physician.Â
Convulsion- convulsion may occur in diarrhoea, your doctor may give anticonvulsant drugs.
Diarrhoeal diseases : Definitions, Types and Causes Read more
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