Diarrhoea and Dehydration

By Oluwatobi Moses Ojo

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 breastfed babies. Diarrheal diseases ranked 9th in the 2018 WHO report on Top 10 Global Causes of Death. Dehydration, on the other hand, is the most severe threat posed by diarrhoea. During a diarrheal 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. Dehydration can be characterized by lethargy/unconsciousness, sunken eyes, skin pitting (skin pinch/press goes back very slowly), restlessness, irritability, drinks thirstily.

Causes

• Infection: Diarrhea is usually a symptom of an infection in the intestinal tract, which can be caused by a variety of bacterial, viral and parasitic organisms most of which are spread by faecal-contaminated water. Infection is common when there are inadequate sanitation and poor hygiene as well as unavailability of potable water for drinking, cooking and cleaning.
• Malnutrition: Children have the most casualty here. Each diarrheal episode, in turn, makes their malnutrition even worse. Diarrhoea is a leading cause of malnutrition and death in children under five years old.
• Source of water: Water contaminated with human/animal faeces, for example, from sewage, septic tanks and latrines, is of particular concern. Animal faeces also contain microorganisms that can cause diarrhoea. Unsafe domestic water storage and handling is also an important risk factor.
• Other causes: Diarrheal disease can also spread from person-to-person, aggravated by poor personal hygiene. Food is another major cause of diarrhoea when it is prepared or stored in unhygienic conditions. Fish and seafood from polluted water may also contribute to the disease.

Prevention and Treatment
Key measures to prevent diarrhoea include:

• access to safe drinking water;
  avoid eating food from street vendors;
• wash your hands regularly with soap and clean water;
  maintain good personal, environment and food hygiene;
  health education about how infections spread; and
  rotavirus vaccination;
• get vaccinated for Hepatitis A and Typhoid before travelling to a developing country

In treating diarrhoea:
Most times diarrhoea isn’t always life-threatening as such over-the-counter medications (OTCs) help feel better, chief of which is Loperamide, which works by slowing down the movement of the gut thus decreasing the frequency of bowel movements and makes the stool less watery; and Zinc supplements, which reduce the duration of a diarrhoea episode by 25% and are associated with a 30% reduction in stool volume.

Taking foods rich in soluble fibre can be beneficial such as oatmeal, peas, ripe bananas, potatoes e.t.c.
Rehydration: with oral rehydration salts (ORS) solution. ORS is a mixture of clean water, salt and sugar. ORS is absorbed in the small intestine and replaces the water and electrolytes lost in the faeces or with intravenous fluids in case of severe dehydration or shock.

Talk to a health professional (Physician or Pharmacist) immediately you notice watery faeces at least three times in a day or when there is blood in the stool or if there are signs of dehydration.

Alternative management tips include:
Staying away from foods that cause or make diarrhoea worse e.g. fatty or fried foods, excess dairy products, caffeinated drinks such as coffee and soda, raw fruits and vegetables, spicy foods, beans, cabbage.

REFERENCES
World Health Organization (2018, May 4). The top 10 causes of death. Retrieved from https://www.who.int/news-room/fact-sheets/detail/

the-top-10-causes-of-death
World Health Organization (2017, May 2). Diarrhoeal disease. Retrieved from https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease