DIARRHOEA

 

 

 

Diarrhoea is usually a self limiting process and is not a disease but a sign of an underlying problem such as an infection or gastrointestinal disorder. Obviously, in many situations this can be very inconvenient.

 

DEFINITION

 

Diarrhoea is generally defined as an increased frequency of bowel movements with the production of soft or watery stools.

 

This results in fluid and electrolyte loss leading to dehydration. Infants and the elderly are more susceptible to diarrhoea and hence dehydration than other individuals.

 

If diarrhoea is not managed properly then it can lead to significant electrolyte loss which sometimes can, in severe cases result in death.

 

WHAT CAUSES DIARRHOEA

 

There are many causes of diarrhoea. Acute diarrhoea which is usually self limiting can result from the following causes:

Dietary factors – eg. High intake of vitamin C, contaminated food and drink

Infection – viral, bacterial                                                                                                                                         

                        Lactose Intolerance

                        Viral gastroenteritis

                    Bacterial gastroenteritis

                        Protozoal gastroenteritis

                        Surgery

                        Laxative abuse

                        Adverse drug reactions – eg. Resulting from antibiotics

 

Infections are probably the most common cause of diarrhoea. Some organisms cause diarrhoea by producing toxins while others cause damage to the lining of the gastrointestinal tract which restricts absorption.

 

More serious or secondary diarrhoea can result from the following causes:

                        Inflammatory bowel disease

                        Irritable bowel syndrome

                        Diverticular disease

                        Endocrine diseases – eg. diabetes

                        Drug withdrawal

 

MANAGEMENT OF DIARRHOEA

 

Symptoms:

Acute diarrhoea has a sudden onset of frequent fluid stools usually accompanied by mild abdominal cramping pain, flatulence and general weakness. Nausea and vomiting may also be present. Acute diarrhoea usually resolves within a few days.

 

Chronic diarrhoea generally occurs secondary to some other disorder.

 

TREATMENT of acute diarrhoea

 

General treatment measures should firstly be to replace fluids lost then reduce the amount of diarrhoea if appropriate. Diarrhoea should be stopped only if the cause is irreversible or for reasons of convenience ( eg. travel, exams etc. ). 

 

Firstly, replacing fluids lost:

Depending on whether the patient is dehydrated or not will determine treatment. Signs and symptoms of dehydration include: thirsty, dry lips, decreased to no urine output, cold, sweaty, sunken eyes, rapid pulse and low blood pressure in severe dehydration.

 

If the patient is NOT dehydrated:

- Give small volumes, frequently of one of the following drinks:

-“normal calorie” cordials diluted 1 in 6 with water ( ie. 1ml of cordial in 6mls of water)      

 - fruit juice drinks diluted 1 in 4 with water or

- fizzy drinks ( softdrinks) diluted 1 in 4 with warm water ( to remove the bubbles)

 

Be aware that these fluids DO NOT contain significant nutrients and starvation is not an appropriate treatment.

 

If the patient is dehydrated: 

Use an oral re-hydrating solution:

 

Pharmacy 777 Glucose and Electrolyte sachets: contain a balance of electrolytes such as sodium, potassium and glucose which aid in the rehydration of the patient and consequently a return to normal bowel movements.

 

Each individual sachet is made up to 200mL with water. In general Adults will require about 400mL for every loose bowel motion and children will require 100mL for every loose motion. The solution is best sipped every 5 to 10 minutes rather than drunk in large amounts less frequently.

 

If in doubt as to whether the person is dehydrated or not it is recommended to use an oral re-hydrating solution in any case.

 

Pedialyte is similar , but has been formulated with different proportions of salts and minerals which are better suited to young children. Hydralyte ice blocks may also be preferred by some parents.as they are already made up into convenient doses.

 

Secondly, reducing the amount of diarrhoea:

Over the counter preparations include:

 

KaomagmaÒ, KaopectateÒ - These are called adsorbents and act by adsorbing water from within the intestinal fluid and hence improves bulk and consistency of stools.

 

Directions: Adult – 15-20mL three times a day.

Adverse effects – constipation if used in mild cases.

 

Note:  They are of no value if the diarrhoea is suspected to be caused by an infection.

 

Pharmacy 777 anti-diarrhoea tablets,Gastrostop ,HarmoniseÒ ( loperamide) and LomotilÒ ( diphenoxylate and atropine) – these medications act by decreasing gastric motility and therefore allow more absorption of water to take place.

 

Dosage: Indicated for 12yrs and older – take two capsules immediately followed by one capsule after each loose bowel motion. Maximum of eight tablets in a 24hr period.

 

Adverse effects: ImodiumÒ - abdominal pain and occasionally skin reactions.  
                                  LomotilÒ - drowsiness, fatigue, dry mouth, decreased urine output, abdominal pain.

 

Note:  These medications are used only for acute symptomatic relief.

           Should not be used in patients with inflammatory bowel disease.

 

Pharmacy 777 GIT and Brauer Stomach Calm is a homeopathic product which can also help in treating diarrhoea in young children.

Dosage: Formula GIT in infants 3 drops under the tingue three times daily (Adult dosage is 6 drops)

 

Other aspects of management of diarrhoea:

 

Diet management:  The patient should eat as little as possible. Any hot or cold foods should be avoided as this may put stress on the gut.

Foods that should be kept to a minimum are dairy products, spicy foods, rich or foods high in fats and oil and protein foods ( ie. red meat, nuts) which are slow to be digested.

 

Foods to eat include dry foods such as low fibre biscuits, water crackers, plain noodles, cooked potato and pumpkin.

 

And of course plenty of fluids.

 

 

WHEN TO REFER TO A PHARMACIST OR A DOCTOR

• Any signs of dehydration (cold clammy skin, changed breathing, vomiting profusely)
• Babies, young children, elderly person who has vomited several times over a few hours
• High body temperature of 40 degrees or more
• Blood in mucus and vomit
• Diarrhoea after an overseas trip

 

 

CONCLUSION 

 

Simple or acute diarrhoea is usually self-limiting and may be controlled with minimal intervention. First line of treatment being oral rehydration therapy. This is particularly important in children and the elderly. Antidiarrhoeal agents are of secondary importance and are useful for the inconvenience associated with diarrhoea.

 

It is important that the patient or carer knows the signs and symptoms of dehydration so that appropriate action can take place when required.

 

It is also important to confirm that the diarrhoea is not secondary to a more serious condition in which case this should be referred promptly.