Diarrhea?

Diarrhea? Vomiting? It's probably gastroenteritis. This illness is characterized by diarrhea, often with accompanying symptoms of nausea, vomiting and/or fever. It is very common in children, and in the United States is caused by a virus 70-80% of the time. A virus called rotavirus is the most common etiology, and this is seen more frequently during the winter months. Various bacteria, including shigella, salmonella, campylobacter and E. coli, can also cause gastroenteritis, but this is in only 10-20% of cases. Parasites such as giardia and cryptosporidium cause approximately 10% of cases of gastroenteritis.

Most cases of gastroenteritis are self limited, and people get better within a few days without the use of medications. However, excessive diarrhea and/or vomiting may result in dehydration, which is the main complication of gastroenteritis. Dehydration is something that can be prevented and/or treated. Infants and small children are at higher risk for dehydration because they have less "extra" fluid to lose.

Prevention of dehydration in infants with diarrhea that aren't vomiting is possible by breast or bottle feeding more frequently than usual. It is not necessary to stop using milk products. In an older child or an adult, a regular diet can be continued if the person is not vomiting, and enough liquids should be taken to replace the fluids lost in the diarrhea. It is recommended that over the counter medications not be used in children without the advice of a physician.

Treatment of mild or moderate dehydration can be accomplished by drinking an increased amount of fluids. Oral rehydration solutions (ORS) such as Pedialyte, Infalyte etc. are the recommended liquids for infants and children. These solutions replace what is being lost in the diarrhea more appropriately than the popular "clear liquid diet." Liquids such as sodas and gatorade have too much sugar, which can actually make diarrhea worse, and broths tend to have too much salt. Even children who are vomiting can be treated with ORS if it is given slowly enough. One to two teaspoons every few minutes should be given originally, with the amount being increased slowly as tolerated. A general rule to follow for the amount of ORS to give is approximately 50 milliliters of ORS per pound of body weight, over four hours. If liquid stools continue during this period, an additional amount of ORS should be added to equal the amount of fluid lost in the stool. Pedialyte, which comes in various flavors, is available locally. A homemade version of ORS can be made by adding one teaspoon of salt and 2-3 tablespoons of sugar to a liter of water. Children tend to prefer the flavored versions of ORS. Once rehydration is underway, and if there is no vomiting, solids can be started. It is best to stick with starches and foods that are easy to digest at first. Foods to avoid include dairy products, sweetened drinks such as soda and fruit juices, caffeine, alcohol and high-fat foods - save these until you are all better!

People often wonder when to see a doctor when they have gastroenteritis symptoms. If one or more of the following is present, a doctor should be contacted: if there is blood in the diarrhea, a continuously high fever, increasing or constant abdominal pain, symptoms persisting longer than 3-4 days, or if there is persistent vomiting. It is also important to have an infant or child evaluated by a doctor if there are signs of more severe dehydration, which include: less than one wet diaper every eight hours, no tears when crying, dry lips and mouth, sunken eyes, and lethargy. Any infant less than 6 months of age with diarrhea and/or vomiting lasting longer than 12 hours should be evaluated by a doctor.