… .or stumbling across the bedroom floor in a B-line
for the bathroom!
To try and write the book on diarrhoea or gastroenteritis
and all that it entails would be a mammoth task indeed. Enough
perhaps to say that each has many causes (infectious, mechanical,
toxic, allergy, emotional etc.). The gut it seems is one of
the most sensitive systems in the human body. It is the first
to react when things start to go awry (remember running for
the loo at exam time, or at that really important job interview
when your stomach starts growling like a discontented dog!).
To find what is really causing your gut wrenching condition
is the job of a skilled physician. The most common form of
the belly burbles is a simple misplaced micro-organism that
is making its presence felt by giving you the gastric rushes!
Fortunately most of these are self limiting (they flush themselves
away), and need little or no treatment. This article will
deal mostly with simple diarrhoea and or vomiting and what
you can do to alleviate the symptoms of this troublesome ailment
and give your self (and your gut ) the best chance of recovery.
l Fluids - Naturally the most important thing to do when
you are losing excess fluid from both ends is to re-hydrate.
Ideally an electrolyte replacement supplement should be used
such as Oralit or Gastrolyte. Needless to say the taste is
less than desirable, so it may be easier to tempt your patient
with a commercially available sports drink such as Gatorade
or Pocari Sweat (especially in younger people). Other fluids
to consider would be herbal teas (mild ginger, peppermint
or camomile are good), and clear non-greasy soups. Remember
always to take fluids in very small amounts frequently. Filling
an irritated stomach quickly will immediately cause a “reject
reflex” and you will lose your load from one end or
another! I even suggest taking fluids with a spoon especially
for children. Avoid coffee, alcohol or cold fizzy drinks,
or anything that may be too acidic (e.g orange juice). The
best juices for a funny tummy would be apple, banana or papaya
juice. These may need to be diluted with water, especially
for babies & children.
l Food - Adjust your diet for easy digestion and allow your
stomach some R&R!. To be honest it does not worry me greatly
when I am told that my patient is not eating, as long as the
fluids are going in. Avoid anything hot or icy cold, as well
as greasy, or spicy foods, and keep the portions small. When
the appetite does return I would suggest light and bland foods
such as porridge, plain white rice with a little soup for
flavour, fruit jellies, yoghurt (live culture type), papaya,
dry toast, semolina etc. Steamed local style soft cakes (lapis,
sumping, bubur, daluman) are excellent.
l Drugs – I rarely use medication for simple gastro-enteritis.
Most commonly prescribed are the “stoppers” and
the “pluggers”. Loperamide (Lomotil) is usually
the “stopper” that is used to reduce the bowel
activity and dry up extra secretions in the gut. Personally
I prefer to let the toxins flush themselves out of the system.
An anti-spasmodic such as Buscopan can be handy to stop those
gut wrenching pains that send you running, although you should
consult with a medico prior to taking this so as to make sure
that the pains are really caused by bowel spasm and nothing
more serious. Pectin and attapulgite combinations (eg supermarket
pills such as Diastop) are “pluggers”, giving
the stool more substance in the gut. Bowel “stoppers”
and “pluggers” are handy to use as a quick fix
if you just cannot avoid leaving the house, or if you are
anticipating a long queue at the airport immigration counter,
but they are by no-means a cure.
l Activities – It goes without saying that if you are
suffering from this condition that “The Gut Rules!”,
and what ever you intend to do, should be planned around an
unpredictable 50 yard dash to the nearest hole in the ground!
Given the questionable conditions of the public lav’s
you might want to pack some extra toilet tissue and some wet
wipes as extra back up. I would avoid the heat or physical
activity which may add to the de-hydration factor. My advice
would be to stay put on familiar ground until the grumbling’s
subside.
When to call in the troops…..(Your G.P. or Health Consultant).
I will usually let a simple case of the trots go for 3 or
4 days as long as the person is other wise well, before I
start further investigation or medication.
Anyone with any of the following symptoms should consult with
their doctor:
l Diarrhoea with severe vomiting for more than 12 hours,
particularly if fluids are not staying down at all.
l Any sign of blood or mucous in the stool. Digested blood
will appear very dark red to black in colour.
l Excessive weakness or lethargy.
l Persons suffering from any metobolic disorder (e.g .Diabetes,
thyroid disorders), and cannot take the regular portioned
diet or medication that they would usually take.
l Fever above 38 C.
l Decreased urine output or very dark urine.
Your doctor will probably do a laboratory stool test which
will detect any abnormalities or infection. Please remember
that the sample should be fresh, not refrigerated and delivered
to the lab ASAP (within the hour). Don’t be alarmed
if your doctor asks you to repeat this test time and time
again, as Ameba are very elusive and can take several smears
to detect.
Babies & Children.
Babies and young children deserve a special mention here,
as due to their size and normal fluid volume they may deteriorate
and dehydrate very, very quickly with gastro-enteritis. I
would suggest that any baby or small child (under 3) should
see a doctor if they have been suffering from vomiting and
diarrhoea for more than 12 hours. Never wait for signs of
dehydration to become apparent. Sunken eyes, fontanelles or
loss of skin turgor are “late “ signs of dehydration.
You should seek treatment a long time before such signs occur.
Maintaining a fluid input and diet for a sick child is also
tricky. Here are a few tips to try for a child with a funny
tummy.
l Breast fed babies should continue to be breast fed, but
may need extra fluids between feeds.
l Formula fed infants should stop their formula and go on
to clear fluids for one or two days, until the milk formula
can be tolerated. Many babies develop a transient lactose
intolerance after a bout of gastro-enteritis and may need
to go on to a lactose free formula (i.e. soy formula). You
may wish to give half strength formula for the first few feeds
until the milk is well tolerated.
l Babies that have recently started solids may prefer to go
back to just the breast or formula. This is fine. Do not introduce
any new foods when a child is ill, and when solids are re-introduced
stick to bland easy to digest foods (e.g. rice cereal, stewed
apple etc.)
l You will need to give a sick child some rehydrating formula
with extra glucose and other electrolytes (e.g. pedialyte).
If you do not have any of these formulas you could try any
of the following:
1. Glucose powder – 2 level teaspoons in 250 mls of
water.
2. Cordial (not low calorie) – 15mls of syrup to 250
mls of water.
3. Fruit juice (apple, pear) – 50mls juice to 250 mls
of water. (Not for babies under 6 months old).
4. Flat soft drinks (not low calorie) – 50mls to 250mls
water.
If you are using oral replacement salts they must be mixed
exactly as instructed; no salt should be added to fluids for
babies or young children.
Prevention.
Once again the old faithful comes to fore when it comes to
preventing food borne illness such as Gastro-enteritis. “Wash
it, cook it, peel it or forget it”, will help to keep
you out of trouble especially when travelling. Attention to
food preparation and storage are essential, and may need to
be re-enforced if you have house staff prepare your meals.
Hand washing (before food preparation, after toiletting) is
another golden standard. Make sure that your wash-basins always
have soap and towels for your staff and guests.
That’s all from me for this edition, and as always
stay happy, stay healthy and stay young!
Kim Patra is a qualified Registered Nurse / Midwife, and
mother of three, who has been living and working in Bali for
past 15 years. She has assisted many traveller (... and others)
either as a flying medical escort or just a voice on the end
of the phone! Kim is happy to discuss any health concerns
that your may have. Her e-mail contact is info@chcbali.com
