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. Here we will limit ourselves to acute variety of diarrhea. 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 gut 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. 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. The standard solution as advocated by WHO contains 20 gm glucose, 3.5 gm Sodium Chloride (common salt), 2.5 gm Sodium bicarbonate and 1.5gm Potassium chloride in 1 liter of water. 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. Practically a salt-sugar solution comprising of a tip (1/8th) of teaspoon of salt and two level teaspoonfuls of normal sugar in a cup (200ml) of water serves the purpose of ORS. 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 is food shouldn’t be denied to a diarrhea patient but it should be modified. Too starchy, too fatty or too sugary food should be avoided. Fruit juices and cola drinks worsen the situation. Although recent studies refute its wisdom, avoiding cow milk or using it in small, frequent portions after diluting it is often useful. Breast- feeding should be continued throughout. Lactose-free milk formulae are sometimes necessary. BRAT (Banana, rice, apple sauce, toast) diet is a popular and effective diet. Rice preparations (e.g. rice kanjee), yogurt and chicken broth are other useful food items in such condition. 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 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 diarrhea more. What are the preventive measures against diarrhea? Breast feeding (in infancy), hand-washing with soap and water after toilet and before food, using clean water, avoiding outside food, proper cleaning and washing of food like meat and vegetables and eating freshly prepared and properly cooked food are some simple preventive measures. Things to remember:
- Most cases of acute diarrhea –whether viral or bacterial- are self-limited lasting for 3-7 days.
- ORS and sensible dietary changes are the only measures required for such cases.
- Lab tests and medicines are mostly unnecessary.
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