Diarrhoea (acute)

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Introduction

  • A very common clinical problem the world over
  • Defined as increase in daily frequency, fluidity, or volume of stools
  • May be acute, chronic, or intermittent
  • Aetiology may be infectious or non-infectious

Clinical features

  • Watery diarrhoea of varying volumes, sometimes with vomiting
  • Bloody mucoid stools
  • Fever
  • Abdominal pain
  • Dehydration
  • Fluid deficit

Complications

  • Hypovolaemic shock
  • Electrolyte imbalance
  • Septicaemia
  • Intestinal perforation
  • Gastro-intestinal bleeding
  • Paralytic ileus

Investigations

  • Stool examination including microscopy, culture and sensitivity
  • Full Blood Count
  • Urea, Electrolytes and Creatinine

Treatment goals

  • Rehydration
  • Correction of electrolyte anomalies
  • Treat underlying cause (where possible)
  • Treat Complications

Drug treatment

• Rehydrate with:
- Oral Rehydration Therapy (ORT): (low osmolarity) for mild to moderate dehydration 500 mL orally over 2 - 3 hours, 3 - 4 times daily
- Intravenous sodium chloride 0.9%
- 1 litre, 2 - 6 hourly for moderate to severe dehydration
- Alternate with Darrow's solution depending on serum potassium
- Children: Use of zinc supplementation
- 6 months and above: 20 mg per day for 10 - 14 days
- Under 6 months old: 10 mg per day
- Specific anti-infective agents for infectious diarrhoea e.g. metronidazole for amoebiasis, giardiasis

Supportive measures

  • Monitor fluid intake/output

Prevention

  • Communal and Personal hygiene
  • Potable water
  • Sanitary disposal of human waste