Diarrhea / Gastroenteritis / Vomiting
Loose watery stools accompanied by abdominal cramps define diarrhoea. While it may be caused by many different organisms and mechanisms, several facts stand out.
in adults the leading cause of diarrhoea is a virus - Noro (previously Norwalk) virus. Its course is self limited, usually lasting one to six days. It is highly contagious, being passed from contaminated stool to oral sources.
In infants and children, the most common cause is a rota virus. This is also self limited. Worldwide, several million children die from diarrhoea almost all of them in situations of poverty.
There are many causes of diarrhoea and abdominal pain. This list has a few of the important ones with their main features:
Food poisoning is caused by toxins typically from food which has been contaminated and left to degrade. The onset of symptoms is rapid - usually under 4 hours. It usually causes severe nausea, abdominal pain and later, diarrhea Fever is extremely unlikely. Common toxins come from:
Staphylococcal - from fecal contamination usually in meat, chicken or eggs
Botulina toxins - usually from improperly tinned or preserved tomatoes
Viral gastroenteritis has a slower onset - usually 12 - 24 hours. It almost always causes nausea then abdominal cramping, vomiting, diarrhea, and fever. The fever helps to differentiate this from food poisoning. Other common symptoms include headache, body aches, joint pain Common viruses include:
rota virus in infants
Noro virus in adults
adenoviruses (one of the causes of childhood rashes resembling fifth disease) and astroviruses (less common)
Bacterial infections may also cause diarrhea In this case, the onset is typically 18+ hours from the time of exposure. The symptoms are indistinguishable from viral illnesses but information about travel can help. Warmer climes and less stringent sanitation make bacterial causes more likely. The most common causes are:
E. coli of several types - always passed fecal - orally, usually in drinking water or water used to 'clean' vegetables - can come from animal feces
Salmonella can often contaminate poultry or eggs
Campylobacter jejuni -
- Giardia - often referred to as "beaver fever"; it is a common contaminant in nature from water, mainly by rodents, but other mammals can also pollute the water supply
Other causes of Diarrhea
Ingestion of excess supplements - particularly Vitamin C and magnesium can cause loose stools. There are a myriad number of causes of diarrhea, including those medically caused, which your physician will help untangle.
Treatment of Diarrhea
Most physicians advise letting diarrhea run it's course if they suspect a viral gastroenteritis. Treatment involves giving adequate fluids and support for energy. Diarrhea is the body's response to the presence of an irritant. In this case, a virus. Healing faster involves getting the virus out of your system but not by blocking it's exit. That means not taking mediations like Immodium™ which work by reducing the muscular action in the large intestine.
What to stop doing when you have diarrhea
- stop all dairy products including yogurt advertised as containing probiotics. Dairy causes worse diarrhea. Breast milk should be continued for infants.
- stop meats of all types - they're hard to digest
- stop drinking large quantities of any liquid in a short time. Even one or two mouthfuls can trigger vomiting.
- stop all sweets,pop, fruit juice, fruit, breads, noodles etc.
What to do for diarrhea
take a specific probiotic - Saccharomyces boulardii . This is available from most pharmacies as Florastor™ and also from health stores. It is available as a powder or capsule and is suitable for all ages. A typical adult dose is 2 caps twice daily for a few days and taper off as the symptoms subside.
take fluids in tiny amounts but very frequently - for a child, a teaspoon full every few minutes is the same as several ounces per hour. Smaller amounts are very much less likely to get vomited up.
drink congee (Chu or Cho in Cantonese/Mandarin), Congee is a salty - sweetened watery rice drink which conforms to the advice given by many pediatric doctors but which you can make yourself.
- use Kaopectate™. This long-time remedy from the pharmacy helps to firm up the stool but overuse can lead to constipation.
How to make Congee
- rice ( 1 cup)
- water (10 cups)
- salt (1 teaspoon)
- maple syrup - real - not sugar syrup with maple flavor
Take one cup of any type of rice and add to ten (10) cups of water. Bring to a boil and add one teaspoon salt. Simmer for two hours. Put through a strainer and throw away the rice. The rice drink should then be sweetened with enough maple syrup to give it a very mild sweet taste. This drink should be the only food for the first day.
Take it in very small quantities - frequently. Generally, about one teaspoon (for children) or one tablespoon (for adults) every few minutes.
As the diarrhoea improves, a congee with the rice left in makes a good first food.
This is highly distressing for everyone but is rarely dangerous unless it continues for more than a day and as long as urine production continues. In infants in diapers, this can be difficult to assess as it may often be accompanied by diarrhoea. In this case, you may need to rely on the other signs of dehydration as your guide for a possible Emergency Room visit.
In almost every case, using congee in small, frequent, amounts works. If there is a fever, parents may be tempted to give medication to reduce the fever which often results in more irritation to the digestive tract and make the situation worse. On the other hand, congee in small amounts, almost always works and soothes the digestive tract.
With prolonged or violent vomiting, the drug Gravol™ may be given as a suppository, or possibly as an injection, in a physician's office or emergency room.
Dehydration is a major risk from vomiting and diarrhea. Its signs are
diminished production of urine
dry mouth and eyes - loss of the ability to tear
skin which becomes doughy - when pulled away from its natural position keeps its new shape instead of snapping back.
Dehydration which does not promptly respond to home remedies must be treated in the hospital.
As the diarrhea subsides, gradually add solid rice, soups, cooked vegetables and fruit but avoid any dairy products for the first few days.