Diarrhoeal diseases

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Diarrhoea is defined as at least 3 liquid stools per day and most often a self-limiting disease.  The high mortality rate from diarrhoeal diseases is due to acute dehydration and malnutrition. Acute diarrhoea lasts less than 14 days while persistent diarrhea lasts between 14-28 days and chronic diarrhoea lasts more than 28 days.

Causes

  • Simple diarrhoea without blood caused by viruses (rotavirus, enterovirus), bacteria Vibrio cholerae, coli, non-typhi salmonella) or parasites (giardiasis).
  • Bloody diarrhoea or dysentery caused by bacteria (shigella, E. Coli, salmonella), or parasites (amoeba)
  • Many conditions such as malaria, respiratory tract infections, irritable bowel syndrome, side effects of medicines may also manifest as diarrhoea.

Signs and symptoms

  • Evaluate state of hydration, nutrition
  • Assess for shock or confusion

Signs and symptoms

Possible type of acute diarrhoea

Profuse watery diarrhoea

Cholera, E. coli

Repeated vomiting

Cholera

Fever

Salmonella, viral diarrhoea

Presence of blood in stools

Shigellosis, amoebiasis

Complications

Most cases are self-limiting but dangerous complications can occur such as:

  • Severe dehydration
  • Sepsis
  • Bowel perforation.
  • Paralytic ileus

Investigations

  • Full blood count
  • Kidney function test
  • Electrolytes
  • Stool for ova, cyst or protozoan, blood culture for bacteria, retroviral status

Treatment objectives

  • Achieve adequate hydration
  • Eliminate cause of diarrhoea (where possible)
  • Treat any complications

Treatment 

Since most cases of acute diarrhoea are self-limited, treatment is mostly symptomatic, focusing on oral rehydration, and rarely requires medication.

  • For rehydration (especially in children) see the section on dehydration in Standard Treatment Guidelines
  • Mild to moderate dehydration: ORS
  • Severe dehydration: Hospitalize and hydrate with IV sodium chloride at 0.9% alternating with Darrow’s solution*, depending on serum potassium
  • Antibiotics: are generally not indicated. Use only when appropriate (i.e. bloody diarrhoea, immunocompromised, elderly or cholera is suspected)
  • Treat underlying conditions in cases of chronic diarrhoea (malnutrition, malaria, etc.)
  • With increased fluids and continued feeding, all children with diarrhoea should be given zinc supplementation at 20 mg for 10–14 days; infants < 6 months should receive 10 mg.
  • Give multivitamins and micronutrients daily for 2 weeks to all children with persistent diarrhoea (folate 50 µg, zinc 10 mg, vitamin A 400 µg, iron 10 mg, copper 1 mg, magnesium 80 mg).
  • For diarrhoea more than 28 days refer to a physician

*Not readily available

Prevention

  • Access to safe drinking water
  • Use of improved sanitation
  • Frequent hand washing with soap and clean water
  • Exclusive breastfeeding for the first six months of life
  • Rotavirus vaccination.

Caution

  • Do not administer anti-diarrhoeal drugs.