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Diarrhoea is defined as the passage of three or more loose or liquid stools per day (or more frequent passage than is normal for the individual). Frequent passing of formed stools is not diarrhoea, nor is the passing of loose, "pasty" stools by breast fed babies. Diarrhoea is usually a symptom of an infection in the intestinal tract, which can be caused by a variety of bacterial, viral and parasitic organisms. Infection is spread through contaminated food or drinking-
Cause & Risk
Infection: Diarrhoea is a symptom of infections caused by a host of bacterial, viral and parasitic organisms, most of which are spread by faeces-
Malnutrition: Children who die from diarrhoea often suffer from underlying malnutrition, which makes them more vulnerable to diarrhoea.
Source: Water contaminated with human faeces, for example, from sewage, septic tanks and latrines, is of particular concern. Animal faeces also contain microorganisms that can cause diarrhoea.
Other causes: Diarrhoeal disease can also spread from person-
The most severe threat posed by diarrhoea is dehydration. During a diarrhoeal episode, water and electrolytes (sodium, chloride, potassium and bicarbonate) are lost through liquid stools, vomit, sweat, urine and breathing. Dehydration occurs when these losses are not replaced. The degree of dehydration is rated on a scale of three. Early dehydration – no signs or symptoms. Moderate dehydration: thirst restless or irritable behaviour decreased skin elasticity sunken eyes Severe dehydration: symptoms become more severe shock, with diminished consciousness, lack of urine output, cool, moist extremities, a rapid and feeble pulse, low or undetectable blood pressure, and pale skin. Death can follow severe dehydration if body fluids and electrolytes are not replenished, either through the use of oral re-
Diagnosis & Treatment
Key measures to prevent diarrhoea include: access to safe drinking-
Zinc supplements: zinc supplements reduce the duration of a diarrhoea episode by 25% and are associated with a 30% reduction in stool volume.
What to do if you have diarrhoea: It is important to drink plenty of fluids to avoid dehydration. Take small, frequent sips of water. You are more likely to become dehydrated if you are also vomiting. It is very important for babies and small children not to become dehydrated. Give your child frequent sips of water, even if they are vomiting. A small amount is better than none. Fruit juice or fizzy drinks should be avoided because they can make diarrhoea worse in children. Contact your GP immediately if your child shows signs of dehydration, such as: irritability or drowsiness passing urine infrequently pale or mottled skin cold hands and feet becoming increasingly unwell.
Children: at increased risk of dehydration, your child's risk of becoming dehydrated is increased if they: are younger than one year old (particularly if they are less than six months) are younger than two years old and had a low birth weight have had more than six episodes of diarrhoea in the last 24 hours have vomited more than twice in the last 24 hours have been unable to hold down fluids have suddenly stopped breastfeeding If you are breastfeeding or bottle feeding your baby and they have diarrhoea, you should continue to feed them as normal. While breastfeeding, you should increase your fluid intake to help maintain your milk supply. You may be able to give your baby oral re-
Children: Your G.P. or pharmacist may recommend giving your child an ORS if they are dehydrated or at risk of becoming dehydrated. The usual recommendation is for your child to drink an ORS each time they have an episode of diarrhoea. The amount they should drink will depend on their size and weight. Your pharmacist will be able to advise you about this. The manufacturer's instructions should also give information about the recommended dose.
Eating: Opinion is divided over when and what you should eat if you have diarrhoea. However, most experts agree that you should eat solid food as soon as you feel able to. Eat small, light meals, avoiding fatty, spicy or heavy foods. If you feel you cannot eat, it should not do you any harm. Make sure you continue to drink fluids and eat as soon as you feel able to.
Children: If your child is dehydrated, do not give them any solid food until they have drunk enough fluids. Once they have stopped showing signs of dehydration, they can start eating their normal diet. If your child is not dehydrated, offer them their normal diet. If they refuse to eat, continue to give them fluids and wait until their appetite returns.
Painkillers: Painkillers will not cure your diarrhoea, but you can take the recommended dose of paracetamol or ibuprofen if you have a fever or a headache. Do not take ibuprofen if you have asthma or stomach, liver or kidney problems. If necessary, you can give your child liquid paracetamol or ibuprofen. Check the patient information leaflet to find out whether it is suitable for your child. Children under 16 years of age should not be given aspirin.
Antibiotics: Treatment with antibiotics is not recommended for diarrhoea if the cause is unknown. This is because antibiotics: will not work if the diarrhoea is caused by a virus can cause unpleasant side effects can become less effective at treating more serious conditions if they are repeatedly used to treat mild conditions Antibiotics may be recommended if you have very severe diarrhoea and a specific type of bacteria has been identified as the cause. They may also be recommended if you have a pre-
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