Gastroenteritis and Dehydration - Dr Kirthi Vidyasagar

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• published: 12 Jun 2015
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Diarrhea is defined as the passing of three or more unformed loose stools. There are three types of diarrhea, one is acute where it can last anywhere between one to seven days. It can be persistent if it is lasting up to one month and it can be known as chronic if it is lasting for more than four weeks. Now the causes of an acute diarrhea could be a virus like your rotavirus, it could be a bacteria like salmonella or shigella, it could be a parasite or protozoa like giardiasis and it could also be induced by an antibiotic. Now the causes for a chronic diarrhea can include inflammatory bowel disease, irritable bowel syndrome, food intolerance like a cow’s milk protein allergy. The symptoms of gastroenteritis include loose stools which can just be watery or it can be mucousy with blood in it and it could be foul smelling. Now some or all of the following symptoms may be present along with this diarrhea. There is vomiting, fever which can be low or high grade, and cramping abdominal pain. Now dehydration is the biggest complication that can be associated with diarrhea and vomiting. What are these signs of dehydration? The child can have sunken eyes, little or no tears upon crying, dry lips and mouth. The soft spot on the scalp can be sunken in infants. There can be increased heart rate, there can be tenting of the skin, there can be decreased urine output, the child may be excessively sleepy or irritable. Severe dehydration can be fatal and should be prevented by early administration of oral rehydration therapy. Do not use homemade ORS solution as the proportion of the electrolytes may be wrong and can cause more harm. Prepare the ORS exactly as per the instructions on the sachets. Now after consulting with your physician, you may want to replace with the recommended quantities of ORS at home for mild dehydration. The fluid replacement accounting for approximately 50ml per kilogram should be accomplished in the first three to four hours in small quantities given every 15 minutes. For example, in infants you could give one to two teaspoons every 15 minutes. In toddlers, you could do three teaspoons every 15 minutes and older children could use about half an ounce every 15 minutes. Now after this three to four hour replacement, you need to then replace with 10ml per kilogram for every loose stool thereafter. Moderate dehydration can be corrected with ORS in an emergency room under medical supervision. If there is severe dehydration, it definitely warrants immediate hospitalization for correction of the electrolyte imbalance by intravenous fluids. In terms of management and supportive treatment, we need to know that viral diarrhea gets better on its own with supportive treatment such as rest and incorporating certain dietary changes such as; do not give your child any fluids or foods containing sugar, avoid dairy products other than yogurt because curd contains lactobacillus which is very good for the gut. You can eat rice and rice based products such as rice, rice congee, khichdi, idlis, etc. Apples, apple sauce, and bananas can be given. If your baby is breastfeeding, continue to do so. If your baby is on a formula, a change to a lactose free formula may be warranted if there is no improvement with all this dietary changes. Feed your baby small amounts frequently to support their caloric requirement through this infection and hydration with fluids, especially your ORS is very important and you can give other fluids like water, tender coconut water, diluted curd which is known as butter milk. Bacterial diarrhea can make your child very sick and will require some investigation of the stool and the blood and will be followed by treatment with appropriate antibiotics by your doctor. Team Ovum Hospitals