Diarrhea Mode of Transmission Ingestion of contaminated food and water.

. Signs and Symptoms Passage of watery stools at least 3x a day. Excessive thirst. Sunken eyeballs and fontanel. Immediate Treatment: Give Oral Rehydration Solution (ORESOL), rice soup (am) to replace lost body fluid. Continue feeding. Prevention and Control: Drink water only from safe sources. If unsure, boil water for 3 minutes or do water chlorination. Eat only foods that are well cooked and properly prepared. Avoid eating street vended food. Keep the food away from insects and rats by covering them using food cover. Wash fruits and vegetables with clean water before eating or cooking. Use toilet when defecating. Wash your hands before eating and after using the toilet. If diarrhea does not stop, consult the nearest health center How is diarrhea treated? Absorbents. Absorbents are compounds that absorb water. Absorbents that are taken orally bind water in the small intestine and colon and make diarrheal stools less watery. They also may bind toxic chemicals produced by bacteria that cause the small intestine to secrete fluid; however, the importance of toxin binding in reducing diarrhea is unclear. The two main absorbents are attapulgite and polycarbophil, and they are both available without prescriptions. Examples of products containing attapulgite are: Donnagel, Rheaban, Kaopectate Advanced Formula, Parepectolin, and Diasorb. Examples of products containing polycarbophil are: Equalactin, Konsyl Fiber, Mitrolan, and Polycarb. Equalactin is the antidiarrheal product containing attapulgite; however the laxative, Konsyl, also contains attapulgite. Attapulgite and polycarbophil remain in the intestine and, therefore, have no side effects outside of the gastrointestinal tract. They may occasionally cause constipation and bloating. One concern is that absorbents also can bind medications and interfere with their absorption into the body. For this reason, it often is recommended that medications and absorbents be taken several hours apart so that they are physically separated within the intestine. Anti-motility medications. Anti-motility medications are drugs that relax the muscles of the small intestine and/or the colon. Relaxation results in slower flow of intestinal contents. Slower flow allows more time for water to be absorbed from

the intestine and colon and reduces the water content of stool. Cramps, due to spasm of the intestinal muscles, also are relieved by the muscular relaxation. The two main anti-motility medications are loperamide (Imodium), which is available without a prescription, and diphenoxylate (Lomotil), which requires a prescription. Both medications are related to opiates (for example, codeine ) but neither has the pain-relieving effects of opiates. Loperamide (Imodium), though related to opiates, does not cause addiction. Diphenoxylate is a man-made medication that at high doses can be addictive because of its opiate-like, euphoric (moodelevating) effects. In order to prevent abuse of diphenoxylate and addiction, a second medication, atropine, is added to loperamide in Lomotil. If too much Lomotil is ingested, unpleasant side effects from too much atropine will occur. Loperamide and diphenoxylate are safe and well-tolerated. There are some precautions, however, that should be observed. Anti-motility medications should not be used without a doctor's guidance to treat diarrhea caused by moderate or severe ulcerative colitis, C. difficile colitis, and intestinal infections by bacteria that invade the intestine (for example, Shigella). Their use can lead to more serious inflammation and prolong the infections. Diphenoxylate can cause drowsiness or dizziness, and caution should be used if driving or performing tasks that require alertness and coordination are required. Anti-motility medications should not be used in children younger than two years of age. Most unimportant, acute diarrhea should improve within 72 hours. If symptoms do not improve or if they worsen, a doctor should be consulted before continuing treatment with anti-motility medications. Bismuth compounds. Many bismuth-containing preparations are available around the world. Bismuth subsalicylate (PeptoBismol) is available in the United States. It contains two potentially active ingredients, bismuth and salicylate (aspirin). It is not clear how effective bismuth compounds are, except in traveler's diarrhea and the treatment of H. pylor//i// infection of the stomach where they have been shown to be effective. It also is not clear how bismuth subsalicylate might work. It is thought to have some antibiotic-like properties that affect bacteria that cause diarrhea. The salicylate is antiinflammatory and could reduce secretion of water by reducing inflammation. Bismuth also might directly reduce the secretion of water by the intestine. Pepto-Bismol is well-tolerated. Minor side effects include darkening of the stool and tongue. There are several precautions that should be observed when using PeptoBismol. Since it contains aspirin, patients who are allergic to aspirin should not take Pepto-Bismol. Pepto-Bismol should not be used with other aspirincontaining medications since too much aspirin may be ingested and lead to aspirin toxicity, the most

common manifestation of which is ringing in the ears. The aspirin in Pepto-Bismol can accentuate the effects of anticoagulants, particularly warfarin (Coumadin), and lead to excessive bleeding. It also may cause abnormal bleeding in people who have a tendency to bleed because of genetic disorders or underlying diseases, for example, cirrhosis, that may cause abnormal bleeding. The aspirin in Pepto-Bismol can aggravate stomach and duodenal ulcer disease. Pepto-Bismol and aspirin-containing products should not be given to children and teenagers with chickenpox, influenza, and other viral infections because they may cause Reye's syndrome. Reye's syndrome is a serious illness affecting primarily the liver and brain that can lead to liver failure and coma, with a mortality rate of at least 20%. Pepto-Bismol should not be given to infants and children younger than two years of age. How can dehydration be prevented and treated? Oral rehydration solutions (ORS) are liquids that contain a carbohydrate (glucose or rice syrup) and electrolyte (sodium, potassium, chloride, and citrate or bicarbonate). Originally, the World Health Organization (WHO) developed the WHOORS to rapidly rehydrate victims of the severe diarrheal illness, cholera. The WHO-ORS solution contains glucose and electrolytes. The glucose in the solution is important because it forces the small intestine to quickly absorb the fluid and the electrolytes. The purpose of the electrolytes in the solution is the prevention and treatment of electrolyte deficiencies. In the United States, convenient, premixed commercial ORS products that are similar to the WHO-ORS are available for rehydration and prevention of dehydration. Examples of these products are Pedialyte, Rehydralyte, Infalyte, and Resol. Most of the commercially available ORS products in the U.S. contain glucose. Infalyte is the only one that contains rice carbohydrate instead of glucose. Most doctors believe that there are no important differences in effectiveness between glucose and rice carbohydrate. Infants and young children. Most acute diarrhea in infants and young children is due to viral gastroenteritis and is usually short-lived. Antibiotics are not routinely prescribed for viral gastroenteritis. However, fever, vomiting, and loose stools can be symptoms of other childhood infections such as otitis media (infection of the middle ear), pneumonia, bladder infection, sepsis (bacterial infection in the blood) and meningitis. These illnesses may require early antibiotic treatment. Infants with acute diarrhea also can quickly become severely dehydrated and therefore need early rehydration. For these reasons, sick infants with diarrhea should be evaluated by their pediatricians to identify and treat underlying infections as well as to provide instructions on the proper use of oral

rehydration products. Infants with moderate to severe dehydration usually are treated with intravenous fluids in the hospital. The pediatrician may decide to treat infants who are mildly dehydrated due to viral gastroenteritis at home with ORS. Infants that are breast-fed or formula-fed should continue to receive breast milk during the rehydration phase of their illness if not prevented by vomiting. During, and for a short time after recovering from viral gastroenteritis, babies can be lactose intolerant due to a temporary deficiency of the enzyme, lactase (necessary to digest the lactose in milk) in the small intestine. Patients with lactose intolerance can develop worsening diarrhea and cramps when dairy products are introduced. Therefore, after rehydration with ORS, an undiluted lactose-free formula and diluted juices are recommended. Milk products can be gradually increased as the baby improves. Older children and adults. During mild cases of diarrhea, diluted fruit juices, soft drinks containing sugar, sports drinks such as Gatorade, and water can be used to prevent dehydration. Caffeine and lactose containing dairy products should be temporarily avoided since they can aggravate diarrhea, the latter primarily in individuals with transient lactose intolerance. If there is no nausea and vomiting, solid foods should be continued. Foods that usually are well tolerated during a diarrheal illness include rice, cereal, bananas, potatoes, and lactose-free products. ORS can be used for moderately severe diarrhea that is accompanied by dehydration in children older than 10 years of age and in adults. These solutions are given at 50 ml/kg over 4-6 hours for mild dehydration or 100 ml/kg over 6 hours for moderate dehydration. After rehydration, the ORS solution can be used to maintain hydration at 100 ml to 200 ml/kg over 24 hours until the diarrhea stops. Directions on the solution label usually state the amounts that are appropriate. After rehydration, older children and adults should resume solid food as soon as any nausea and vomiting subside. Solid food should begin with rice, cereal, bananas, potatoes, and lactose free and low fat products. The variety of foods can be expanded as the diarrhea subsides.