diarrhoea dos and donts

Diarrhoea dos and don'ts

http://www.telegraphindia.com/1151019/jsp/knowhow/story_48726.jsp

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Your Health - Dr. Gita Mathai

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Thousands of adults and children in India suffer from diarrhoea every day. The disease - caused by bacteria, viruses or parasites - is food or water borne and the result of contamination.

The symptoms of "food poisoning" may set in within 12-24 hours or can be delayed for 7-10 days. The delay sometimes makes the diagnosis difficult as by then people have forgotten what they ate. The severity of symptoms varies from person to person depending on the number of bacteria consumed and the general health and immune status of a person. Young children, the elderly, pregnant women, and anyone whose immunity is low (on steroid medication, cancer treatment or in an immunocompromised state like infection with HIV) is likely to be severely affected.

Contaminating organisms are killed when food is cooked at high temperatures. If the cooking process is too rapid, organisms can survive in the relatively raw middle portions of the food. They can remain dormant there and then start to multiply.

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Contamination with bacteria belonging to the staphylococcus family can occur before, during or after the cooking process. The bacteria release heat stable toxins into the food. The bacteria may die during the cooking process but the toxins are unaffected. They cause the stomach upsets.

A dangerous form of food poisoning called Botulism is caused by toxins released by a bacteria called C. botulinium. The spores of the bacteria contaminate the food, the organisms multiply and release toxins. Later, cooking may kill the organism but the toxin remains. In infants the infection is caused by direct ingestion of spores of the organism in contaminated food, usually unpasteurised milk or honey. In addition to the vomiting and diarrhoea (which may be relatively mild) the nerves are affected. There may be blurred vision, droopy eyes and lethargy. Muscle weakness and respiratory paralysis can set in. Antitoxin has to be administered. The person also needs supportive treatment and respiratory support. The diagnosis may be missed because the incubation period can be long (days).

The usual culprits in causing diarrhoea are salmonella, shigella and E. coli. These bacteria are present in the stools of patients and healthy asymptomatic carriers. Food may be contaminated by the fecal-oral route if hands are not washed properly. Surfaces in contact with raw or cooked food should be washed and wiped regularly and frequently with soapy water. The local mithaiwala should wear disposable gloves when he weighs your sweets and savouries.

Sewage contamination of the water supply can occur because the water and sewage pipes run close to each other. Water should be boiled before it is drunk, or only bottled water should be used. Fresh cut fruits and vegetables are also potent sources of infection. Sometimes, they are also sprinkled with contaminated water in the summer months to preserve their appetising appearance.

Food poisoning produces mild fever, vomiting and profuse watery diarrhoea with mucous or sometimes blood. There may be stomach cramps and tenesmus (a painful desire to unsuccessfully pass motion). As more and more stool is passed, or vomiting makes it impossible to retain fluids, dehydration can set in. The volume of urine becomes scanty or may cease altogether. The temperature may rise.

There is no need to rush to a doctor when diarrhoea sets in. Your gut needs rest to cope with the bacteria and the toxins. Keep yourself hydrated with sips of water or by sucking on ice cubes. Cook kichdi in a pressure cooker with equal quantities of rice and dal. Add salt to taste and then boil again with water till it is a flowing consistency. Take a tablespoon of this mixture every ten minutes and alternate it with water. You can also alternate the kichdi with bites of yellow banana. Once the gut has rested for 24 hours, spontaneous recovery can occur.

Self-medication with single doses of antibiotics, metronidazole or enteroquinone is dangerous and can lead to the emergence of resistant organisms.

Lomotil and loperamide can reduce the frequency of diarrhoea without eliminating the causative organism. Repeated doses should not be taken. It should not be used in children under the age of 10.

Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in