Diarrhea Health Article

Rehydration

Drinking fluids such as tea, sport drinks, fruit juices and some mildly carbonated beverages, augmented with water, will rapidly replace fluid lost through diarrhea. Fluids should be consumed as rapidly as affected persons will tolerate them. Experts recommend fluid intake levels of 50-200 mL/kg/day. Severely dehydrated individuals may require hospitalization and intravenous fluid therapy with lactated Ringer's solution. Persons who do not require hospitalization can make a similar solution that can be taken orally at home. Combine the following:

• 0.5 teaspoon salt•
• 1.0 teaspoon baking soda
• 8 teaspoons water
• 8 ounces orange juice
• water to equal 1 quart

Diet

If persons with diarrhea consume adequate carbohydrates and fluids, most will avoid dehydration. Fluids that contain electrolytes are especially useful. Broth-based soups with crackers, sport drinks and some soft drinks contain salt, potassium, sugar and bicarbonate. These substances are lost with diarrhea. The bowel should not be stressed during recovery from diarrhea. This can be accomplished by avoiding foods that are high in fiber, fatty foods, milk and dairy foods, alcohol and caffeine. Eating relatively small meals on a frequent basis is helpful. Tea and fruit juices provide nourishment without stressing the digestive system.

Antidiarrheal agents

Persons with mild to moderate diarrhea usually benefit from antidiarrheal preparations. If diarrhea does not subside or worsens with the use of such agents, they should be discontinued and competent medical assistance sought. Preparations containing opioids (such as loperamide) should not be used by persons with bloody diarrhea or high fevers. In others, they will decrease stool liquidity, quantity and tenesmus. The following preparations are generally useful:

• bismuth subsalicylate (Pepto-Bismol)
• loperamide (Imodium AD)

Antibiotic therapy

For the majority of persons with diarrhea, the condition is self-limiting. As such, antibiotic therapy is not indicated. For persons with moderate to severe diarrhea, antibiotic therapy may be helpful. Symptoms of bloody stools, fever and tenesmus are indications for the use of an antibiotic. The following are often used while awaiting the results of a stool culture. Because they are used without accurately identifying a causative agent for the diarrhea, their use is characterized as empirical.

• a fluoroquinolone such as ciprofloxacin
• erythromycin
• trimethoprim/sulfamethoxazole

Antibiotics are indicated for persons with so-called traveler's diarrhea or for diarrhea that is caused by cholera, shigellosis or salmonellosis.

Prognosis

Most cases of diarrhea are self limiting. Once the causative agent or toxin is discharged with the fecal flow, recovery can begin. Over 90% of persons with acute diarrhea will recover fully with adequate rehydration or the use of antidiarrheal agents. Laboratory determination of the cause in such instances is infrequently required. The cost is not justified. Laboratories identify approximately 3% of causative agents from stool cultures.

Laboratories will frequently examine stool samples for the presence of blood to differentiate inflammatory and non-inflammatory causes of diarrhea. After a diagnosis of inflammatory diarrhea has been made, stool cultures are needed to determine appropriate antimicrobial therapy.

Hospitalization for diarrhea is uncommon but warranted for severe diarrhea. Babies and older persons are at increased risk for adverse outcomes, including death, from diarrhea.

Each day, more than 1,700 babies around the world die from diarrheal diseases. Most of these are due to a lack of potable drinking water. With adequate hydration using non-contaminated water, most of these deaths could be prevented. Without clean drinking water, their prognosis is often poor.

Health care team roles

Diarrhea is usually diagnosed by someone other than a professional member of a health care team. Treatment is often provided by the same person. When professional advice is sought, a family physician, internist, pediatrician, physician's assistant or nurse practitioner is most likely to be consulted. A laboratory technician may process stool samples and identify a causative agent. In unusual circumstances, a pathologist may be called upon to identify a causative pathogen. A specialist in infectious diseases may provide assistance. Epidemiologists and sanitarians have an interest in diarrhea outbreaks or clusters of cases. Health officers may be called upon to take preventive measures if food sources, public restaurants or day care centers are shown to be the causes of a diarrhea outbreak.