Diarrhea

About Diarrhea

• Diarrhea is an increase in the frequency of bowel movements, an increase in the looseness of stool or both.
• Diarrhea is caused by increased secretion of fluid into the intestine, reduced absorption of fluid from the intestine or rapid passage of stool through the intestine.
• Diarrhea can be defined absolutely or relatively. Absolute diarrhea is defined as more than five bowel movements a day or liquid stools. Relative diarrhea is defined as an increase in the number of bowel movements per day or an increase in the looseness of stools compared with an individual's usual bowel habit.
• Diarrhea may be either acute or chronic, and each has different causes and treatments.
• Complications of diarrhea include dehydration, electrolyte (mineral) abnormalities (due to salt loss), and irritation of the anus.
• Dehydration can be treated with oral rehydration solutions and, if necessary, with intravenous fluids.

Oral Rehydration Solutions

Oral Rehydration Solutions: Made at Home

• The most effective, least expensive way to manage diarrhoeal dehydration
• The "simple solution" Do-It-Yourself.... Encouraging self-reliance
• The most effective, least expensive way to manage diarrhoeal dehydration

To prevent too much liquid being lost from the child's body, an effective oral rehydration solution can be made using ingredients found in almost every household. One of these drinks should be given to the child every time a watery stool is passed.

Ideally these drinks (preferably those that have been boiled) should contain:

• Starches and/or sugars as a source of glucose and energy,
• Some sodium and
• Preferably some potassium

The following traditional remedies make highly effective oral rehydration solutions and are suitable drinks to prevent a child from losing too much liquid during diarrhoea:

• Breast milk
• Gruels (diluted mixtures of cooked cereals and water)
• Carrot Soup
• Rice water  -  congee

A very suitable and effective simple solution for rehydrating a child can also be made by using salt and sugar, if these ingredients are available.

If possible, add 1/2 cup orange juice or some mashed banana to improve the taste and provide some potassium.

Molasses and other forms of raw sugar can be used instead of white sugar, and these contain more potassium than white sugar.

If none of these drinks is available, other alternatives are:

• Fresh fruit juice
• Weak tea
• Green coconut water

If nothing else is available, give water from the cleanest possible source

(If possible brought to the boil and then cooled).

Footnote:

People often refer to home-prepared oral rehydration solutions as "home-brew."  This should be discouraged because the word brew implies:

• Either fermenting which in fact is an obstacle to some home-prepared solutions especially those made with rice-powder
• Or it implies boiling (as in tea) which, especially with sugar and salt or using packets of ORS, should not be done because it decomposes the sugar, or caramelises

Recipe for home-made salt and sugar solutions

Preparing a 1 (one) liter oral rehydration solution [ORS] using Salt, Sugar and Water at Home.

Mix an oral rehydration solution using one of the following recipes; depending on ingredients and container availability:

Ingredients:

• One level teaspoon of salt
• Eight level teaspoons of sugar
• One liter of clean drinking or boiled water and then cooled

5 cupfuls (each cup about 200 ml.)

Preparation Method:

Stir the mixture till the salt and sugar dissolve.

An efficient and effective homemade remedy to be used when watery diarrhea strikes and is a good substitute for oral rehydration salts

Ingredients:

• 1/2 to 1 cup precooked baby rice cereal or 1½ tablespoons of granulated sugar
• 2 cups of water
• 1/2 tsp. salt

Instructions:

Mix well the rice cereal (or sugar), water, and salt together until the mixture thickens but is not too thick to drink.

Give the mixture often by spoon and offer the child as much as he or she will accept (every minute if the child will take it). Continue giving the mixture with the goal of replacing the fluid lost: one cup lost, give a cup. Even if the child is vomiting, the mixture can be offered in small amounts (2-1 tsp.) every few minutes or so.

• Banana or other non-sweetened mashed fruit can help provide potassium
• Continue feeding children when they are sick and to continue breastfeeding if the child is being breastfed

Questions on Solutions made at home

Q.  How do I measure the Salt and Sugar?

Different communities use various methods for measuring the salt and sugar.

• Finger pinch and hand measuring, and the use of local teaspoons can be taught successfully
• A plastic measuring spoon

Whatever method is used, people need to be carefully instructed in how to mix and use the solutions.

Do not use too much salt. If the solution has too much salt the child may refuse to drink it.  Also, too much salt can, in extreme cases, cause convulsions. Too little salt does no harm but is less effective in preventing dehydration.

A rough guide to the amount of salt is that the solution should taste no saltier than tears.

Q.  How much solution do I feed?

Feed after every loose motion.

Adults and large children should drink at least 3 quarts or liters of ORS a day until they are well.

Each Feeding:

• For a child under the age of two

Between a quarter and a half of a large cup

• For older children

Between a half and a whole large cup

For Severe Dehydration:

Drink sips of the ORS (or give the ORS solution to the conscious dehydrated person) every 5 minutes until urination becomes normal. (It's normal to urinate four or five times a day.)

Q. How do I feed the solution?

• Give it slowly, preferably with a teaspoon.
• If the child vomits it, give it again.

The drink should be given from a cup (feeding bottles are difficult to clean properly). Remember to feed sips of the liquid slowly.

Q.  What if the child vomits?

If the child vomits, wait for ten minutes and then begin again. Continue to try to feed the drink to the child slowly, small sips at a time.

The body will retain some of the fluids and salts needed even though there is vomiting.

Q.  For how long do I feed the liquids?

Extra liquids should be given until the diarrhoea has stopped. This will usually take between three and five days.

Q.  How do I store the ORS solution?

Store the liquid in a cool place. Chilling the ORS may help. If the child still needs ORS after 24 hours, make a fresh solution.

10 Things you should know about Rehydrating a child

1. Wash your hands with soap and water before preparing solution
2. Prepare a solution, in a clean pot, by mixing
• One teaspoon salt and 8 teaspoons sugar
Or
• packet of Oral Rehydration Salts (ORS)
• With one litre of clean drinking or boiled water (after cooled)

Stir the mixture till all the contents dissolve.

1. Wash your hands and the baby's hands with soap and water before feeding solution
2. Give the sick child as much of the solution as it needs, in small amounts frequently
3. Give child alternately other fluids - such as breast milk and juices
4. Continue to give solids if child is four months or older
5. If the child still needs ORS after 24 hours, make a fresh solution
6. ORS does not stop diarrhoea. It prevents the body from drying up. The diarrhoea will stop By itself
7. If child vomits, wait ten minutes and give it ORS again. Usually vomiting will stop
8. If diarrhoea increases and /or vomiting persists, take child over to a health clinic