DIARRHOEA

Occurrence of 3 or more loose watery stools in 24 hrs.

Acute diarrhoea: ≥ 3 loose, watery stools within 24 hours
Dysentery: bloody diarrhoea, visible blood and mucus
Persistent diarrhoea: episodes of diarrhoea lasting more than 14 days

Causes

  • Viruses: Rotavirus, Norovirus , adenovirus, measles, hepatitis A virus , hepatitis E virus, Ebola
  • Bacteria: Vibrio cholera, E.coli , Salmonella, shigella, campylobacter
  • Protozoa: giardiasis, malaria, cryptosporia
  • Heliminthes e.g. strongyloidiasis, schistosomiasis
  • Infectious diseases, e.g. measles, malaria, and other fever causing conditions
  • Malnutrition e.g. kwashiorkor
  • Drugs e.g. prolonged use of purgatives and broad-spectrum antibiotics
  • Unhygienic feeding methods
  • Malabsorption syndrome
  • Lactose intolerance
  • HIV associated-diarrhoeas
  • Irritable bowel syndrome
  • Metabolic: diabetes, thyroid disease
  • Travellers’ diarrhoea
  • Inflammatory bowel disease (persitent diarrhoea usually bloody)

Clinical features

  • Loose watery stools
  • Abdominal cramps
  • Dehydration – thirst, sunken eyes, loss of skin elasticity, low urine output
  • Signs of malnutrition if diarrhoea persists for > 14 days
  • Blood in stool (in dysentery)

Investigations

  • Stool: Microscopy, C&S
  • Other investigations may be necessary according to history and physical examination

Red flags

  • Fever
  • Extremes of age
  • History of travel from a known endemic area
  • Dysentery
  • Shock, failure to feed, mental confusion

Management

  • Prevent or correct dehydration with ORS or IV fluids according to treatment plans A, B or C
  • Find and treat the cause if indicated
    • Avoid inappropriate use of antibiotics e.g. metronidazole, ciprofloxacin
  • Routinely use zinc supplementation, at a dosage of 20 milligrams per day for children older than
    six months for 10–14 days
  • Prevent or treat undernutrition and micronutrient deficiencies

Persistent or chronic diarrhoea:

  • Adults only: As above plus codeine phosphate 30 mg every 8-12 hours as required
  • Child: vitamin A
    • 6-11 months: 100,000 IU; 1-6 years: 200,000 IU

Prevention

  • Vaccination: measles, rotavirus, polio, hepatitis A virus
  • Notify in case of suspected epidemics e.g. cholera, hepatitis A or E virus infections, Ebola
  • Encourage handwashing, use of clean drinking water, and proper waste disposal