Diarrhoea and rehydration

There are many causes of dehydration in the human body. Any set of circumstances that can upset the integral balance of water and electrolytes can have serious results if not identified and rectified expediently. The delicate balance of input and output of fluid is essential to maintain optimum health, an excessive loss of body fluids will shift he state of internal homeostasis. Globally, dehydration-related  infant mortality remains a great challenge to Public Health authorities and regular policy updating takes place to empower care givers to prevent this, largely preventable, occurrence.

Causes of dehydration

The most common cause presented at Primary Health Care facilities is dehydration resulting from diarrhea. We will thus examine this condition.

Diarrhoea is described as the frequent passing of unformed, watery bowel movements. Irrespective of the cause of diarrhoea the primary approach remains constant namely to identify the cause and eliminate it (or avoid it), to replenish the lost fluid in a medically sound manner and to prevent the re-occurrence and the transmission to others. Outbreaks of diarrhea in communities are notifiable to Health Authorities in order for health plans to be made and implemented to prevent disasters and increased burden of care on Public Healthcare facilities.

When a client presents at the pharmacy and reports the onset of an acute (or of longer duration) bout of diarrhea, a detailed history should be taken before any management plan is formulated. If a food related 9food poisoning) risk presents, advise the client to action accordingly (suspected spoiled food should be destroyed or if at a public facility, inform the management in case other patrons have been affected) This gastro-enteritis is viral in origin and is accompanied by nausea.  A common cause of diarrhea is TD or ‘traveller’s diarrhoea’ and caused by the bacterium, Escherichia coli (E.coli) Unfortunately, many a tourist is affected by this food-bourne bacterium and many a much deserved vacation is spoilt and cut short by severe diarrhea. The condition is self-limiting and generally lasts about 3-4 days. The best advice one can offer is to prevent the diarrhea by avoiding uncooked fruit or vegetables when traveling. An anti-diarrheal medication such as Lomotil® or Immodium® can be administered. Once the fluid loss has been rectified the general malaise should improve. Rehidrat®, Electropak® and Gastrolyte® will restore the body’s fluid and electrolyte balance.

A client experiencing diarrhea might report the additional symptoms of headache, colicky pain or cramping, tenesmus, excessive thirst, decreased urine output, lethargy, dizziness when standing due to orthostatic hypotension, sunken eyes, sunken fontanelles in infants. The most visible symptom of dehydration is the loss of skin turgor seen in wrinkling and shriveling of skin (when the skin of the forearm is pinched it should return to its normal smooth state immediately, if not suspect dehydration)

To replace the lost fluid, advise the client to drink copious volumes of non-fatty liquids such as flat cola or ginger ale (remove the bubbles by stirring to avoid irritating the gut).  An adult’s intake of fluid is approximately 2000ml per day.  Should the diarrhea have caused and excessive loss of body fluid, this volume should be replaced. Advise the client to drink water but exercise care so that electrolytes do not remain too low to re-establish the desired homeostasis. It is therefore better to use a specially formulated isotonic replacement fluid such as Rehidrat® or Scripto-Lyte®. These are available in pleasant-tasting sachets to reconstitute with potable water (very convenient for travelers).

Should acute diarrhea last for longer than two to three days, a medical practitioner should examine the patient and decide whether an intravenous replacement of fluid is prudent. If the loss of body fluid has been so great that will not be possible for sufficient replacement fluids to be absorbed through the gastro-intestinal tract, a drip will be started. There are of course limiting factors such as availability of facilities and resources, therefore one should attempt to avoid this final resort.

As the pharmacy is such an important first stop for the community, it is incumbent on the Pharmacist Assistant to provide clients with good preventative advice. To prevent the diarrhea from being transmitted from one family member to another, proper hand-washing must be practiced after using the toilette.  No one with diarrhea should be permitted to touch or prepare food for consumption in the home or outside. Travelers should be advised to keep a tube of waterless alcohol based hand cleanser on hand, should they find themselves in facilities where proper hand-washing is not possible.  Detol® handsanitiser are very convenient, remind the client to follow the instructions as only then these alcohol rubs are effective.

In closing, one must stress that this article has discussed diarrhea in adults. Diarrhea in babies and young children is more likely to be a medical emergency as infants cannot withstand much body fluid loss and tend to become dehydrated very fast. The more fluid loss due to watery stools the more urgently the baby should be examined and treated by a medical practitioner.

The following home remedy can be used as an emergency measure if there is a delay in reaching a medical facility:

• Discontinue the baby’s usual feed
• Prepare a sterile solution of one tablespoon of sugar in one litre of boiled water to which half a level teaspoon of table salt has been dissolved
• Administer 15-20ml at a time, at hourly intervals

Conclusion

Dehydration caused by diarrhea can be a life-threatening condition but generally it is a situation that occurs quite commonly and can be managed at a Primary Health Care level.

Dale Joynt Hons B Soc Sc IMM