Diarrhea

Diarrhea

Diarrhoea is defined as the abrupt onset of abnormally high fluid content in the stool: more than the normal value of approximately 10 mL/kg/d in the infant and young child, and more than 200 g/d in the teenager and adult, in the setting of western diet (low fibre diet). This term is also used to denote loose or watery stool.

Acute versus Chronic

Acute diarrhoea = acute onset, lasts no more than 14 days

Chronic diarrhoea (persistent diarrhoea) = diarrhoeal episode lasts longer than 14 days

Why is it important? It’ll give a clue about epidemiological, cause and treatment.

Good to know (observe)

Although it sounds strange, but when you experience diarrhoea, it’s important to observe these following things:

  • Frequency
  • Appearance: just loose, watery, blood or mucus in stool
  • Each time volume: large versus small
  • Others: day-care history, food history, water exposure, camping history, travelling history

Why is it important? It’ll give a clue about the organism (virus, bacteria, parasite) causing the diarrhoea, and source of the diarrhoea (small versus large bowel).

Please bear in mind that most organisms take days to start showing the symptoms (incubation period). Some even take up to 1 week although some others take only hours. So, don’t always blame the food you take hours prior.

Cause:

–       Food intolerance or food allergies

–       Surgical conditions: acute appendicitis, intussusceptions

–       Infections: virus, bacteria, and parasite

–       In children, virus is the most common cause of diarrhoea

Complication:

–           In paediatric/children population à failure to thrive/grow

–           Dehydration

The most common complication, affecting all populations. Babies and children are far more prone to it. The younger the age, the more they are prone to dehydration. The general rule, younger than 4 years old is definitely more prone.

Reason:  they have higher body water contents (Water comprises approximately 70% of body weight in infants, 65% in children, and 60% in adults)

Never underestimate dehydration; it can be fatal.

Focusing in paediatric: How to recognize dehydration early?

–           Less urine

–           Thirsty

–           Dry mouth or lips

–           Not as active as they normally are

–           No tears while crying

–           \In babies, sunken fontanella

–           Less active

–           Lost of weight

–           Lethargic, even unconscious

–           Electrolyte imbalance, also may lead to fatal conditions

Self Treatment:

–           Fluid, fluid and fluid: small amounts but often

–           Not all diarrhoea requires antibiotics. Some diarrhoea can even be dangerous if you take antibiotics.

When to go to a doctor:

  • Bloody diarrhoea
  • Fever
  • High-output diarrhoea
  • Persistent vomiting
  • Signs of dehydration
  • Inadequate responses to oral rehydration therapy (ORT) or caregiver unable to administer ORT
  • Anti-diarrhoeal agent, loperamide, should not be used in case of infectious diarrhoea

 

Prevention:

–           It is always better to prevent than to treat

–           For children, since the most common cause of diarrhoea is rotavirus, now Indonesia has the rotavirus vaccine and it is available at BIMC Hospital.

–           The rotavirus vaccine is not injection, but oral suspension (kind of syrup), consisting of 2 doses; 1st dose after 6 weeks old, preferably before 16 weeks old and 2nd dose should be completed before 24 weeks old.

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BIMC Hospital Nusa Dua
The first hospital in Indonesia with accreditation from Australian Council on Healthcare Standard International  (ACHSI)

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