Diarrhea: Treatment

Two things must always be considered:(1) the degree of dehydration, (2) is drug treatment necessary? The most important thing with acute diarrhoea is to deal with dehydration and in the second place to correct protein and calorie deficiency. Aetiological treatment will only be possible in a minority of cases, but should not be disregarded.

Children are very sensitive to dehydration. Fluid loss can occur very quickly with vomiting and diarrhoea: 500 ml of fluid in a child weighing 5 kg means a loss of 10% of body weight and implies a high risk of death.

IV rehydration is not always possible nor even desirable. An important development has been the discovery that many cases of dehydration of whatever origin can be counteracted by oral rehydration. This is possible because despite the diarrhoea, the mechanisms for absorbing water, sodium and glucose in the intestine are maintained. The minimum ingredients for this oral rehydration solution (ORS) are clean water, glucose and salt. While this can indeed bring about rehydration or prevent dehydration, a disadvantage is that the diarrhoea itself continues. The volume of stools is not reduced. Alternatives to glucose are ordinary sugar (sucrose; this is a glucose-fructose disaccharide) or rice powder. Rice powder is better because it reduces the volume of stools. In ideal circumstances potassium (against hypokalaemia) and bicarbonate or sodium citrate (against acidosis) can be added. Citrate is easier to store than bicarbonate. In the future there may perhaps be better formulae which also contain neutral amino-acids (glycine and alanine) and perhaps dipeptides.

The WHO has developed a standard formula. Each litre of water should contain:

Under field conditions the following guidelines can be used :

1 teaspoon of salt + 6 teaspoons of sugar + 1 litre of boiled water.

Category: Medical Subject Notes , Medicine Notes