Diarrhea Treatment

By Dr Ananya Mandal, MD

In most cases of diarrhea the condition resolves on its own in a day or two. These types of diarrhea do not require assessment, diagnosis and treatment other than prevention of dehydration. The body’s immune system gears up to fight and remove the infection.

How long does diarrhea last?

In children diarrhea may take around 5 to 7 days to pass. In all the symptoms of diarrhea usually do not persist over two weeks.

When caused by rotavirus infection diarrhea may last for around three to eight days, with norovirus it is around two days and with bacterial infections like campylobacter and salmonella, diarrhea may last two to seven days.

Those infested with parasites like giardia may take several weeks to recover fully. In patients who suffer from periods of diarrhea lasting for over four weeks, it is termed chronic diarrhea.

Some of the measures adopted for treatment and prevention of complications include:-

Plenty of fluids should be taken

Diarrhea leads to increased loss of fluids and electrolytes like, Potassium and Calcium in the watery stools.

Normally gut absorbs these fluids and electrolytes while food passes through it. During an infection the gut fails to absorb the water or the infection and inflammation leads to copious secretion of water into the intestinal lumen. This leads to the water loss.

Excessive water and electrolyte loss may cause dehydration. One of the primary and most important treatment approaches to a case of diarrhea is to replenish the water and electrolytes. Babies and the elderly with diarrhea are most at risk of dehydration.

The person should be offered frequent sips of water and oral rehydration solution (ORS) prescribed by the World Health Organization.

ORS is available without a prescription and comes in sachets. These contain several salts and glucose. The contents of the sachet are dissolved in water and taken in small sips.

Children should be given an ORS each time they have an episode of diarrhoea. The exact amount of ORS they should drink will depend on their size and weight.

Even if the child or the person is vomiting, fluids may be offered by mouth. Fizzy drinks should be avoided as they may make the diarrhea worse.

If the child is breastfed or bottle fed, that should be continued.

In older children and adults healthy and nutritious food needs to be taken in small amounts to prevent malnutrition that may be seen after long episodes of diarrhea.

Fatty, spicy and heavy foods should be avoided. If there is vomiting and dehydration, fluids are given until the dehydration is corrected before introducing foods.

Intravenous fluids

When dehydration is severe, hospital admission may be required. In these cases intravenous fluids are given to replenish the lost water and electrolytes.

As soon as the patient is able to take fluids by mouth and vomiting stops, ORS may be started.

Medications

There are a few antidiarrheal medicines that may control diarrhea and shorten the duration by around a day. These are, however, not essential and are not prescribed normally.

Loperamide is one such agent. It shows the movement of the muscles in the intestines and thus prevents diarrhea.

Being in contact with the intestinal wall for a longer duration, the excess water is absorbed. This leads to formation of semisolid stools.

Antidiarrheals should not be taken if there is blood or mucus in stools or if there is high fever that indicates a more severe infection. Children should not be given antidiarrheal medicines at all. Pain and fever relievers like paracetamol may be used in cases of fever.

Antibiotics are another class of medications that may be given when the cause of diarrhea is diagnosed. If the cause is unknown, antibiotics are not recommended. This is because antibiotics can act only on bacteria and fail to help in viral diarrhea and also lead to side effects of their own.

Home treatment

  • Home treatment in a child with no dehydration includes:-
    • Plenty of fluids including ORS. In absence of OR,S food based home fluids like gruel, soup, unsalted or salted yoghurt drink, green coconut water, weak tea, unsweetened fresh fruit juice or rice water may be given. Fluids to be avoided include fizzy drinks, sweetened tea, sweetened fruit drinks or coffee.
    • Continuing feeding, breast or bottle feeding
    • Administering Zinc as supplemental tablets for 10 to 14 days.
    • Teaching the mother to be vigilant about the symptoms of dehydration in the child.
  • Home treatment in a child with some dehydration includes:-
    • ORS and extra fluids. ORS is given until the skin pinch test is normal and the child is calm and not thirsty. this usually takes four hours of rehydration
    • Continuing feeding, breast or bottle feeding
    • Administering Zinc as supplemental tablets for 10 to 14 days after rehydration is achieved
    • Teaching the mother to be vigilant about the symptoms of dehydration in the child and returning to the health center in cases of return of the symptoms
  • Treatment of a child with severe dehydration:-
    • Hospital admission is needed
    • Intravenous fluids are given to correct the dehydration rapidly
    • ORS should be given as soon as the child can take it even along with an IV drip
    • Zinc therapy is instituted once the dehydration is corrected

Reviewed by , BA Hons (Cantab)

Sources

  1. http://www.nhs.uk/Conditions/Diarrhoea/Pages/Treatment.aspx
  2. http://www.choa.org/Menus/Documents/Wellness/teachingsheets/diarrhea.pdf
  3. http://www.unicef.org/media/files/Final_Diarrhoea_Report_October_2009_final.pdf
  4. http://s3.gi.org/patients/gihealth/pdf/diarrheal.pdf
  5. http://www.csun.edu/~shcenter///pdfs/education/diarrhea.pdf
  6. http://www.izincg.org/publications/files/USAID_DiarrENGL.pdf
  7. http://digestive.niddk.nih.gov/ddiseases/pubs/diarrhea/Diarrhea_508.pdf

Further Reading

Last Updated: Mar 24, 2013

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