Diarrhoea
Diarrhoea = Increased frequency of bowels evacuation + watery fasces + gripping pain
Diarrhoea is a defense mechanism of the human body to expel toxin, bacteria and harmful substances from the intestine
Most cases of diarrhoea will be acute and self-limiting
The basis of treatment is fluid and electrolyte replacement especially for infants and elderly patients
Antidiarrhoeals may be used in adults and older children
Antibiotics are not recommended for uncomplicated gastroenteritis
They are given only for some severe cases of food poisoning
Causes of Diarrhoea
A. Viral Infections
Viruses often cause gastroenteritis esp. in children < 2 years old
Associated symptoms are those of cold, such as fever and vomiting
The acute phase is usually over within 2-3 days
The infection is usually self-limiting
B. Parasitic/ Protozoan Infections
These infections may occur in travelers, who acquire the infection and return with the organism, e.g. amoeba, worm
Diagnosis is made by sending stool sample to the laboratory and appropriate treatment is necessary
C. Bacterial Infections
1. Cause of food poisoning
2. When poultry is undercooked
3. Contaminated food reheated insufficiently
Salmonella is one of the bacteria responsible for food poisoning, whose symptoms may arise 12-48 hours after ingesting the infected food
An abrupt onset of frequent diarrhoea, occasionally with abdominal pain and vomiting
Antibiotics for Salmonella are best avoided, except in extreme situations
The main stay of treatment is fluid replacement
The bacteria are eliminated quickly from the bowel
D. Chronic Diarrhoea
Recurrent or persistent diarrhoea due to irritable bowel syndrome, e.g. stress, anxiety, bowel tumor or an inflammation, e.g. ulcerative colitis or Crohn’s disease
Antidiarrhoeals, bulk-forming agents and sometimes corticosteroids are required
E. Change of Diet
1. Lactose intolerance may result in osmotic diarrhoea
2. Changing from breast milk to cow’s milk in infant
Bottle-fed babies may suffer from osmotic diarrhoea resulting from insufficient dilution of milk
F. Drug-induced Diarrhoea
Certain drug may cause diarrhoea,
e.g. Antibiotics, Magnesium antacids, Metformin
Management of Diarrhoea
Diet Intake
1. The food must be well done and personal hygiene is important
2. Bland diet is recommended while milk products should be avoided
3. For children changing from breast milk to cow’s milk, small and frequent meal should be given
4. World Health Organization (WHO) recommends that
4.1. Breast-fed babies should continue feeding and increase the frequency of breast-feeding to at least every 3 hours in order to increase the nutrient and fluid intake
4.2. For bottle-fed babies milk powder should be diluted with twice the usual amount of water and be given every 3 hours for children over 6 months
Oral Rehydration Therapy
1. The standard treatment for acute diarrhoea in babies and young children
2. Contain sodium as chloride and bicarbonate, glucose and potassium
3. The absorption of sodium is facilitated in the presence of glucose
Preparation Available of Diarrhoea
GES 45 (KCI 380mg, NaCI 230mg, NaHCo3 420mg, Glucose 5.77g)
Pedialyte solution (sodium, potassium, chloride, citrate, glucose)
When to refer of Diarrhoea
If there are any signs of dehydration, the
child should be referred to the physician
