Gastro-Enteritis
This is an extremely common condition affecting the digestive tract resulting in nausea/vomiting and/or diarrhoea. It is usually caused by a virus, less commonly by other infectious agents, toxic chemicals in the food or a food allergy. The symptoms arise from the body’s effort to rid itself of the offending cause. Since there is no way to kill the virus (or counter the toxin or the allergy), treatment in all cases is the same – fluid replacement. Of course we do have drugs available to stop the vomiting or the diarrhoea, but here they are quite illogical as they literally ‘sabotage’ your own natural bodily defences. The only danger, then, is of dehydration – excessive loss of body fluids from the diarrhoea/vomiting, and an adequate fluid replacement program will prevent this from happening.
Here are some hints:
1. Vomiting does not lose the whole drink – at least some is kept in the stomach; just wait 20 minutes and try again.
2. Although diarrhoea may occur immediately after the drink (especially in babies), this is not the fluid ‘going right through’, but the act of swallowing stimulating the lower bowel to empty its contents. However, this fluid was just ‘sitting there’ and not available to the body anyway. Unless actually vomited, the fluids taken by mouth are always fully absorbed.
3. With frequent vomiting, give small frequent drinks; in a baby this may be as little as 2 fluid ounces every hour; a teaspoonful of fluid every one or two minutes might be needed in a severe case of vomiting.
4. When caused by a virus, you are usually infectious until the diarrhoea has stopped and up to 3 days afterwards. Infection among family members can be reduced by careful hand-washing – especially after using the W.C. or changing nappies, and before meals. Wash nappies in the usual way, but put “Milton” in the nappy buckets.
When should I re-consult with the doctor?
1. If the patient is becoming dehydrated. Warning signs include: a. passing none or only small amounts of very strong urine. b. Dry mouth and eyes. c. becoming drowsy or floppy. d. Not taking fluids by mouth.
2. Griping pains with diarrhoea and soreness from the vomiting are usual, but severe or persistent pains should prompt you to seek medical advice as other conditions such as appendicitis may rarely mimic gastro-enteritis.
3. A slight rise in temperature is fairly common, but a very high fever or other symptoms such as breathlessness, cough, abnormal drowsiness or confusion should prompt a call for urgent advice.
4. If the diarrhoea becomes bloody.
5. Diarrhea not getting better by Day 5.
The Diarrhoea Diary
Day 1: Use “Dioralyte” or “Rehydrat” only, carefully following the manufacturer’s instructions which accompany the product; use at half strength if this is all the baby will accept. In an emergency (i.e. if Dioralyte/Rehydrat are not instantly available) a pint of water with a tablespoon of sugar and a pinch of salt may be used for a short time. Fluid replacement must continue as long as the diarrhoea or vomiting persists.
Day 2: Toast and standard (not “Dairy”) Ice Cream.
Day 3: Toast, ice cream, potatoes and gravy, or small amounts of well-cooked chicken white fish or egg. Give extra fluids throughout. Do not give milk, fruit or vegetables!
Day 4: Gradually build up to a full diet but beware of fruit, vegetables and especially milk for the first week.
Don’t be tempted to give increased food for the first 3 days; this delays recovery; toddlers quickly put on weight in the second and third weeks.
O.K., we do very occasionally prescribe and anti-diarrhoeal medicine for social “emergencies” such as giving a speech in the house of commons, playing for Stoke City or trying to conduct a surgery. However, such ‘treatments’ invariably prolong the illness; you are far better advised to simply replace the fluids as outlined and just ‘sit it out’!
Good Luck!
Bernard Shevlin