Friday, January 30, 2015

Diarrhea, Causes, Complications, Prevention and Treatment

Diarrhea is defined as having three or more loose or liquid stools per day, or as having more stools than is normal for that person.

Classification
(a)   Based on onset of symptoms

• Acute
• Chronic

(b)   Based on absence or presence of blood/mucous

• Secretary Diarrhea
• Inflammatory Diarrhea

Causes of Diarrhea

• Viruses
• Bacteria (common in food poisoning)
• Laxative abuse
• Diseases of Intestine
• Malabsorbtion syndrome
• Colon cancer

Complications of Diarrhea

• Dehydration
• Electrolyte disturbances
• Dehydration occurs when there is excessive loss of fluids and minerals (electrolytes) from the body due to
Diarrhea, with or without vomiting i.e. Electrolyte disturbances. Dehydration is common among adult patients with acute Diarrhea who have large amounts of stool, particularly when the intake of fluids is limited by lethargy or is associated with nausea and vomiting. It also is common in infants and young children who develop viral gastroenteritis or bacterial infection. Patients with mild dehydration may experience only thirst and dry mouth. A prolonged bout of Diarrhea or vomiting can cause the body to lose more fluid than it can take in. The result is dehydration, which occurs when your body doesn’t have the fluid it needs to function properly. Severe dehydration can cause Renal Failure or kidneys to shut down. Dehydration can be particularly dangerous in children and the elderly.

Know the Signs of Dehydration

If one is sick with Diarrhea or vomiting, watch carefully for these signs of dehydration:

• Thirst
• Less frequent urination than normal
• Dark-colored urine
• Dry skin
• Fatigue
• Light-headedness
• Inability to sweat

By the time these symptoms show up, however, dehydration may be well advanced. At the first sign of Diarrhea or vomiting, begin replacing lost water and the essential salts called electrolytes.

Classifications of dehydration in a child with Diarrhea:

• Severe dehydration
• Some dehydration
• No dehydration

How to Prevent Dehydration

When one is sick with Diarrhea or vomiting, one tends to lose fluid rapidly. So it’s important to take in as much fluid as possible. Drinking plenty of water is the top priority. The amount of water required is to replenish depends on how much is being lost.

Water rehydrates the body. But water alone doesn’t replace the essential salts required by the body for fluid balance and other functions. Most experts recommend drinking oral rehydration solutions.

Moderate to severe dehydration may cause orthostatic hypotension with syncope (fainting upon standing due to a reduced volume of blood, which causes a drop in blood pressure upon standing), a diminished urine output, severe weakness, shock, kidney failure, confusion, acidosis (too much acid in the blood), and coma.
Electrolytes (minerals) also are lost with water when Diarrhea is prolonged or severe, and mineral or electrolyte deficiencies may occur. The most common deficiencies occur with sodium and potassium. Abnormalities of chloride and bicarbonate also may develop.

Preventing Dehydration in Children

Children can lose a tremendous amount of fluid in a short time from Diarrhea or vomiting.  In addition to routine signs of dehydration, parents of sick infants and children should also watch for dry mouth and tongue, no tears when crying, listlessness or crankiness, sunken cheeks or eyes, sunken fontanel (the soft spot on the top of a baby's head), fever, and skin that does not return to normal when pinched and released also known as Skin pinch test.

If your sick child shows signs of dehydration, give fluids called oral rehydration solutions. Sport drinks and fruit juices are helpful too, but they don’t provide the ideal balance of water, sugar, and salt.

Treatment

The goal of treatment is to ease the symptoms and get the bowel movements back to normal. People don't always need to take medication for Diarrhea.

Drugs like Antibiotics and antimotility agents should be used only after consultation with doctor.

Oral Rehydration Solutions:

Made at Home the most effective, least expensive way to manage Diarrheal dehydration.

The Simple Solution “Do-It-Yourself...” Encouraging self-reliance made at home: ORS Solution a special drink for Diarrhea.

Give the child a drink made with 6 level teaspoons of sugar and 1/2 level teaspoon of salt dissolved in 1 litre of clean water.

Be very careful to mix the correct amounts. Too much sugar can make the Diarrhea worse. Too much salt can be extremely harmful to the child.

ORS packets are available from health centers, Chemist shops.

Following traditional remedies make highly effective oral rehydration solutions and are suitable drinks to prevent a child from losing too much liquid during Diarrhea:

• Khichdi or Gruels (diluted mixtures of cooked cereals and water)
• Carrot Soup
• Rice water
• If none of these drinks is available, other alternatives are:
• Fresh fruit juice
• Weak tea
• Green coconut water
• If nothing else is available, give Water from the cleanest possible source (If possible brought to the boil and then cooled).

It is advised mothers must continue breast feeding their infants.  

How is the ORS drink prepared?

Put the contents of the ORS packet in a clean container. Check the packet for directions and add the correct amount of clean water. Too little water could make the Diarrhea worse.

Add water only. Do not add ORS to milk, soup, fruit juice or soft drinks. Do not add sugar.

Stir well, and feed it to the child from a clean cup and clean spoon. Do not use a bottle.

How much ORS drink to give?

Encourage the child to drink as much as possible.

A child under the age of 2 years needs at least 1/4 to 1/2 of a (250-ML) cup of the ORS drink after each watery stool.

A child aged 2 years or older needs at least 1/2 to 1 whole large (250-ML) cup of the ORS drink after each watery stool.

Preventing Dehydration in the Elderly People

Seniors are at increased risk of becoming dehydrated because they may not be as sensitive as younger adults to the sensation of thirst. In addition, age-related changes in the body’s ability to balance water and sodium increase the danger.

To decrease the incidence and prevalence of Diarrheal disease in India through safe drinking water

While continuous efforts have been made to provide drinking water in India over the past decade, the tremendous adverse impact of unsafe water on health continues. The highest mortality from Diarrhea is in children under the age of five, which calls for urgent focused interventions to prevent Diarrheal disease in this age group.

Despite investments in water and sanitation infrastructure, many low-income communities in India continue to lack access to safe drinking water. Regardless of the initial water quality, widespread unhygienic practices during water collection and storage, poor hand washing and limited access to sanitation facilities facilitate the transmission of Diarrhea-causing germs through the faecal-oral route.

Improved hygiene and sanitation also play an important role in reducing Diarrheal and other water-borne diseases. Motivation is required to bring about behavioral changes necessary for improved hygiene and sanitation Main emphasis is to raise... Read More

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