Management of Acute Diarrhoea

Abstract

Before 1970, laboratory staff could not only identify the causative organism of acute diarrhea in 20% of cases, but in 1990, they could identify it in 80% of cases. These organisms are either bacteria, virus, or parasites. The bacteria include enterotoxigenic bacteria (Vibrio cholerae, enterotoxigenic Escherichia coli, Clostridium perfringens, and Staphylococcus aureus) and enteroinvasive bacteria (Campylobacter jejuni, C. coli, and Salmonella and Shigella species). The leading cause of death in diarrhea patients is dehydration. Oral rehydration solutions (ORS) can alleviate mild and moderate dehydration regardless of the etiology of the diarrhea or the age of the patient. WHO recommends an ORS containing glucose and various electrolytes which permit salt and water absorption in many cases of acute diarrhea. Due to the possibility of excess salt entering the bloodstream (hypernatremia), some pediatricians do not use the WHO recommended ORS in newborns and young infants. Instead they use 2 parts ORS followed by 1 part water. This treatment is not easy for illiterate mothers to follow, however. Continued breast feeding during diarrheal episodes along with administration of ORS protects not only against dehydration, but also hypernatremia. ORS should not be administered in severe case of dehydration, however. Medical personnel need to administer replacement fluid such as Ringer's Lactate solution intravenously regardless of the age group. Once the initial deficit has been controlled, ORS administration and reintroduction of foods can follow. Antibiotics should only be administered if the medical personnel suspect severe cholera in an endemic area (tetracycline and furazolidone); shigellosis, but 1st the bacteria must be tested to see if the strain is multiple drug resistant (ampicillin, trimethoprim-sulphamethoxazole, furazolidone, nalidixic acid), and acute amebiasis or giardiasis (metronidazole and tinidazole). Antidiarrheals should not be used.