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Diarrhea

[29th December, 2012]

Diarrhea is passage of three or more loose or liquid bowel movements in a day. It is common in all ages but seen very frequently in infants and young children. There can be a number of causes of diarrhea.

Why should one be worried in case of diarrhea?

The loss of fluid in diarrhea can lead to:

  • Dehydration (loss of fluid).
  • Salt (electrolyte) imbalance.
  • Weakness

Causes:

There are multiple reasons for diarrhea but the common causes are:

  • Infections
    • Bacterial
    • Viral like rotavirus
    • Protozoal like amoebiasis, giardiasis
  • Malabsorption
  • Inflammatory and irritable bowel syndrome
  • Others like:
    • Chronic ethanol ingestion
    • Ischaemic bowel disease, etc.

Management:

The main aim of management of diarrhea is to correct dehydration and salt imbalance. Therefore the thrust is on the following:

  • Fluids:
    Person having diarrhea should have plenty of fluids orally, like:
    • Lemonade
    • Coconut water
    • Buttermilk / lassi / matha
    • ORS (oral rehydration solution)
    • Plain water
    • Intravenous fluids, if required. See Danger Signs below.
  • Diet:
    The patient should be provided a meal which is easily digested and assimilated like:
    • Rice / khichri
    • Potatoes
    • Over-ripe banana
    • Curd
    Fruits and fruit juices should be avoided as they can increase the frequency of motion
  • Medicines:
    In most of the cases where the diarrhea is generally non-specific in nature no medicine is suggested.
    Medicines, if required, are prescribed according to the cause of diarrhea. They fall in the following classes:
    • No antibiotics are given for viral diarrhea
    • Antibiotics if the diarrhea is bacterial in origin
    • Metronidazole for amoebiasis and giardiasis
    • Probiotics like lactobacillus to modify the intestinal flora
    • Binding agents like bismuth salt
    • Any other medicine depending on the specific cause
  • Hygiene:
    It is important to ensure that hygiene is well maintained by the food handlers and for the patient. This involves:
    • Proper hand washing after defecation
    • Proper hand washing before handling food
    • Keeping nails trim and clean
    • Utensils are clean
    • Feeding bottles and nipples for babies are boiled for at least 15-20 minutes before feeds and are not washed after boiling (which is a very common practice).

Investigations:

If the diarrhea is persisting then the following investigations are done:

  • Stool routine examination
  • Stool culture and sensitivity, if necessary
  • Electrolyte levels if the condition of the patient warrants hospitalization

Danger Signs:

One should immediately admit a patient with diarrhea if:

  • Loose motions are not getting controlled
  • Patient is:
    • Drowsy
    • Irritable
    • Running high fever
  • Not passing urine for more than 6-8 hours
  • Unable to accept orally

Other issues:

With repeated passage of loose motions the perineal region (anus and urinary passage) can become sore and red. This can be controlled by keeping the area dry and application of lubricant in the form of bland oil/cream locally.

Dr. Rajiv K. Khandelwal
Director & Chief Pediatrician, Vardaan Hospital
Chief Editor, Indian Journal of Clinical and Experimental Pediatrics

Chairman Messagemore

chairmanpicVardaan Hospital is a New Delhi based Super Speciality Healthcare Hospital

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