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CAUSES, SYMPTOMS AND DIETARY MODIFICATIONS OF DIARRHOEA
Diarrhoea is characterized by the frequent evacuation of liquid stools, accompanied by the excessive loss of fluid and electrolytes especially sodium and potassium.
Based on severity and duration diarrhoea can be classified as acute and chronic diarrhoea. Acute diarrhoea is the sudden onset of frequent stools of watery consistency, abdominal pain, cramping, weakness and sometimes fever and vomiting. This lasts for 24 to 48 hours. Nutritional losses are not a prime concern.
Diarrhoea is chronic when it persists for 2 weeks or longer. Nutritional deficiencies develop as the rapid passage of intestinal contents does not allow sufficient time for absorption.
Diarrhoea results from changes in the mucosa of the small and large intestines.
Diarrhoea may be due to many causes. The more common causes are:
· Viral Infection : e.g. 'intestinal' flu, a common term for infection of the bowels by the influenza virus and rota virus.
· Bacterial Infection : 50 percent of the cases are due to
bacterial infections of the gut. Bacteria produce toxin in the
gut e.g. Vibrio cholerae, Shigella
1. Food poisoning : Poor food hygiene and improperly handled food as a result of food being prepared with unwashed hands, food exposed to flies or cockroaches, or left at room temperature for a long time.
2. Allergy : Allergy and food intolerance to certain foods or medicines.
Diarrhoea means passing loose or watery stools several times a day.
It is usually a symptom of an inflamed intestine or bowels. The inflammation results in food hurrying through the bowels. This leaves too little time for water to be absorbed from the bowel contents back into the body.
Diarrhoea can be uncomfortable especially when accompanied by abdominal pain, nausea, vomiting or fever. Diarrhoea can lead to dehydration.
Watch out for dehydration
Diarrhoea only becomes dangerous if you get dehydrated or lose too much body fluids. Vomiting and fever will both speed up the dehydration.
Babies below one year of age have a higher chance of getting dehydrated because they have so little body fluids to begin with. Adults and children who can drink freely to replace the salts and water lost are in no danger.
Signs of dehydration
1. Inelastic skin
2. Dry lips and mouth
3. Furred tongue
Sunken fontanelle (the soft spot on a baby's head)
Do the pinch test
Pinch up the skin on any part of your arm or abdomen and let go. Normal skin springs back into place at once. Inelastic skin sags back slowly.
Because diarrhoea is a symptom of a disease state, the aim of medical treatment is to remove the cause. The next priority is management of fluid and electrolyte replacement and finally attention to nutrition concerns.
The loss of body fluids should be replaced by a liberal intake to prevent dehydration. Water, fruit juice, vegetable soups, rice kanji with salt, fresh lemon with sugar or honey can be given.
Losses of sodium, potassium and other electrolytes cause weakness. Potassium is necessary for normal muscle tone of the gastrointestinal tract. Anorexia, vomiting and weakness occur unless losses are replaced.
Deficiencies of vitamin B12, folic acid and niacin occur due to decreased intake of vitamins. Iron deficiency occurs due to the increased loss of iron in the faeces.
In acute diarrhoea over 1500 kcal daily and in chronic diarrhoea about 2500 kcal are given.
Easily assimilable protein rich foods are given if tolerated.
Fats are restricted as they are not always absorbed and may aggravate diarrhoea.
A low residue diet, i.e. diet low in fibre is recommended. A non - irritating diet consisting of soup, biscuits, rice, sago, arrow root, potato and skimmed milk can be included. Pectin from cooked apple helps in controlling diarhoea. Green leafy vegetables with a high residue should be restricted. When diarrhoea begins to lessen, fibre can be gradually incorporated in the diet to restore normal bowel motility.
Spices, pulses, fried foods and fibrous vegetables are to be excluded.
Diet in Chronic diarrhoea
Low milk, then milk free and starch free diet can be given as represented in table 12.1.
Acute diarrhoea in weaning can be due to indigestion. When
weaning food is introduced too early the infants' digestive system is not ready for digestive enzyme secretion and diarrhoea can result.
Strategies for lowering incidence of weanling diarrhoea.
1. Encouragement of breast feeding
2. Better food hygiene
3. Improvement of nutritional status of children
4. Clean food and
5. Environmental sanitation are important strategies for lowering the incidence of diarrhoea.
The infant should continue to be breast fed during the attack of diarrhoea. Breast milk contains viable phagocytes and other protective substances which protect against most enteropathogens.
Milk should be diluted with equal volume of clean boiled water and fed along with Oral Rehydration Salt Solution (ORS) till the diarrhoea stops. Though there will be a temporary increase in the frequency of motions, recovery will be faster. Buttermilk whey can also be included as it has a beneficial effect. It discourages growth of pathogenic bacteria.
For older children cooked rice and lentil is usually well tolerated. Precooked ready to mix cereal pulse mixture prepared from roasted and powdered rice, wheat, black gram and powdered sugar in the ratio 1:1:1:2 can be given.
In adults, nutritional care includes replacement of lost fluids and electrolytes by increasing the oral intake of fluids high in sodium and potassium. Pectin from cooked apples helps to control diarrhoea. When the diarrhoea stops, starch foods like rice, potato can be given followed by protein foods. Fats need to be limited if the individual is healthy. In chronic diarrhoea, nutrients should be replaced parenterally and enterally. When diarrhoea begins to lessen, the addition of normal amounts of fibre help to restore normal bowel motility.
1. Any food exposed to flies and dust must be strictly avoided.
2. When eating out avoid all uncooked foods, food touched by hands before serving or foods prepared under unhygienic conditions.
3. Food that is served hot as freshly made chapattis, toasted bread, idli and cooked vegetables, are safe to consume.
4. Cold foods served as meat, curd and butter milk are best avoided.
5. Fresh fruits must be peeled by the consumer.
6. Hot tea and water that has been boiled should be taken.
7. Tender Coconut water taken with a clean straw is the safest drink.
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