Diarrhoea can vary from a mildly annoying bowel dysfunction to a life-threatening disease, especially in very young children and infants, leading to dehydration and death quite rapidly. It is therefore essential to know how to treat it in the absence of immediate medical assistance.
Diarrhoea may be brought on by various causes, ranging from food poisoning to food allergy, drug side-effect, overdose of laxatives, or plain simple anxiety. Even malaria can present initially as diarrhoea. Whatever, the cause, it is important to realise that the rapid and continuous depletion of fluids and salts from the body can cause dehydration of brain function, delirium and even death.
Depending on the duration of the onset of symptoms, diarrhoea is either acute or chronic. It is, of course, acute diarrhoea that we are discussing here because of the rapid deterioration of the patient's condition that it can cause. In chronic diarrhoea, the patient has enough time to go to a doctor for treatment.
Even in diarrhoea of abrupt onset, a lapse of anything from 12 hours to three days occurs between the time the organism invades the body and the time that symptoms occur.
Signs & Symptoms
It is important to note that one does not need to have watery stools to be suffering from diarrhoea. The passage of soft or semi-solid motions also constitutes diarrhoea.
Below, the symptoms that indicate diarrhoea:
- The passing of frequent motions that are unformed/ formed/ soft/ semi-solid/ watery.
- Abdominal pain.
- Fever.
- Accompanying symptoms like appetite loss, nausea, headache, bodyache, giddiness, uneasiness, weakness and prostration.
Some patients may have two to three loose motions for whatever reason and become all right. Others may not get better; they might in fact get worse. You'll know that the patient is serious when:
- He has passed several motions (over 4-6), either solid, semi-solid, or watery.
- His appearance is not normal - he has a pale, cold, clammy skin (or, alternately, fever and abnormal sweating - which could be a sign of food poisoning.)
- Nervousness, restlessness and anxiety may also be present.
- His tongue is dry, he feels thirsty all the time.
- He experiences sudden weakness; he cannot walk about and wants to lie down.
- His pulse is feeble; his blood pressure is low.
- He has persistent vomiting, malaise, and headache.
The mainstay in the management of any diarrhoeal disorder is the maintenance of fluid and salt balance in the body. When a person starts losing body fluids through loose motions, sweat, vomiting, blood, etc., the lost volume must be replaced immediately to enable the various organs, including the brain, to work effectively.
- Give plenty of fluids to the patient. Plain water is best - but make sure it's clean, preferably boiled or purified. As soon as you realise you have a diarrhoea patient on your hands, boil a lot of water and keep it to cool for future use. Give it to the patient - as much as he can comfortably drink.
- To replace depleted salts, give coconut water, salted rice water, salted lime juice (squeezed out of fresh lemons), weak tea (it exerts an astringent action on the intestinal mucosa, causing it to retain water; too strong tea, on the other hand, is a diuretic.) These days there are a number of electrolyte powders (such as Electral) available in the market; some are quite safe, some not, and all need to be given in the right proportion which only a doctor can really guide you about. Also, many of these preparations have such strong salts in them that they cannot be given to hypersensitive, heart patients, diabetics, etc. instead of these, try the Oral Rehydration therapy (ORT) given below. This is now the WHO-recommended remedy for dehydration: Squeeze the juice of one fresh lemon into two glasses of water, add 5 teaspoonful of sugar and a pinch of salt, and stir. Keep giving this to the patient at regular intervals of 15 minutes to half an hour. If he cannot drink too much at a time due to nausea or weakness, let him take it in small sips. One word of caution: make sure the ORT fluid is made from clean preferably boiled water.
- Do not give glucose. This might aggravate the motions since glucose changes the intestinal flora - the bacteria present naturally there.
- Have the patient lie down in a cool room and relax. Reassure him, because anxiety itself can cause more loose motions.
- If he feels nauseous, put a few drops of freshly-squeezed lemon juice on his tongue.
- Restrict solid foods. They might stimulate bowel movements.
- Once the patient appears better and the motions less frequent, you can give him curds, rice, boiled apples, mashed bananas, baked potatoes, jelly and toast - all these are constipating foods.
- A little mint juice or a couple of soda mint tablets may also be helpful, especially when there is stomach pain.
- Avoid giving tablets like 'Lomotil' (which stops loose motions by checking intestinal motility), until recommended by a qualified doctor. Without doctor's recommendation such drugs could be dangerous.
- If the patient is vomiting excessively, promethazine can safely be given even to children and infants, in the proper dosage; another choice is domperidone.
- If the vomiting and loose stools cannot be quelled, it is best to take the patient to a hospital or arrange for an I.V. drip at home.
In developing countries, about 60 to 70 per cent of babies suffering from diarrhoea die from dehydration, showing that replacement of fluids could have saved their lives.
How do you recognize diarrhoea in children and babies?
In a breast-fed infant, the stools are normally liquid and soft and a baby may usually pass 3 to 7 stools per day - at intervals of a few hours. If the number stools goes up to 10-12 passed very frequently, and the motions are watery, it means that the child has a diarrhoeal disease that requires prompt attention.
Signs of dehydration include:
- Thirst/ Dry tongue.
- Sunken eyeballs.
- Depressed fontanelles (the two soft areas, one at the front and the other at the back of a bay's skull that only become hard after complete fusion of the skull bones, by 18 months - these appear concave or depressed in the sick child.)
- Fever.
- Loss of appetite, malaise, weakness, prostration, headache and vomiting.
- Blood and mucus in the stools.
- Cold, clammy, sweaty skin, especially in the extremities which can become ice-cold.
Give water orally immediately - clean, boiled water (filtering doesn't kill germs and a baby has much less resistance than an adult). Feed an infant either through a sterilized feeding bottle or with a washed spoon. You have to give the child frequent sips or gulps of water till it looks better.
For salt replacement, the same relief measures apply as for adults. (Fresh coconut water, salted lemon juice or ORT). For ORT, put 6 to 8 teaspoon of sugar, half to one teaspoon of salt and the juice of half of a lemon in one litre of boiled water; stir and give sips from time to time. A smaller quantity, made in the same proportions, can also be prepared, since the fluid must be used up within six hours to retain freshness.
Other liquids that can be fed to older children are whey and weak tea.
In a young child, ORT can be given in the proportion of half a glass every 15-20 minutes, for a few hours. In a one-year-old child, 1 litre must be fed every 24 hours, and after every motion 100 ml. of water or ORT should be repeated. In an infant a few months old, a quarter to half the amount fed to a year-old child may be given.
The same precautions that apply to an adult (e.g. about glucose and medications) also apply to a child.
In a breast-fed infant, do not stop the feeds (unless advised by a doctor for a specific reason).
Babies on formula feeds must be given diluted preparations of the feed.
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