Gastroenteritis: The Dos and don’ts

Jan 15, 2017 Dr Zulfikar Bux

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Dr Zulfikar Bux

Assistant Professor of Emergency Medicine 

We have all had the displeasure of having an episode of vomiting or diarrhea or both. It’s not the

best feeling in the world and can make our lives very uncomfortable. Medication, illicit drugs, pregnancy and other medical conditions are less common causes of vomiting and diarrhea, but our main focus today is on gastroenteritis, caused by viruses and bacteria.

WHAT IS GASTROENTERITIS? 

Gastroenteritis is defined as inflammation of the stomach and intestines, typically resulting from bacterial toxins or viral infection and causing vomiting and diarrhea. It can be mild or more severe which can lead to dehydration and even death. It accounts for 1.4 million deaths worldwide yearly, and therefore should be taken seriously. Children are more prone to the debilitating effects of gastroenteritis and most of their complications arise from dehydration.

We will therefore focus more on the management in children, especially since they get dehydrated easily.  Dehydration occurs when there is too little fluid in your body, causing inefficient blood circulation. When one vomits or has diarrhea, they are constantly losing fluids which if not replaced, will lead to dehydration.

By knowing what to do and what not to do, you may be able to ride out an episode of Gastroenteritis.

WHAT CAN YOU DO?

In otherwise healthy children, most cases of mild gastroenteritis gradually go away within a few days. In the meantime, you can try the following suggestions:

• To prevent dehydration, encourage your child to drink plenty of fluids. Your doctor may recommend a particular brand of over-the-counter oral rehydration solution in addition to breast milk, formula or milk. In general, these solutions are better than soft drinks, fruit juice or other sweetened beverages, which usually have too many carbohydrates (sugar) and too little sodium (salt) to restore normal fluid balance in children with gastroenteritis. Do not use water alone. They also need essential electrolytes (potassium, sodium etc.) that would have been lost during the vomiting or diarrhea. Coconut water, pedialyte, gatorade, oral rehydration salts etc. are alternatives for rehydration that have electrolytes
• If your child is too nauseated to drink his or her normal intake of fluids at one sitting, try offering several smaller sips more frequently over a longer period.
• Once your child’s vomiting subsides, resume a normal diet gradually while continuing the oral rehydration solution. Begin with lean meats and complex carbohydrates, such as rice, potatoes and bread. Temporarily avoid fatty foods and sugary beverages. If your child is breastfeeding, resume nursing as soon as possible.
• Do not give your child anti-diarrhea medicines without checking with the doctor first. These medicines can interfere with the intestine’s ability to pass harmful viruses, bacteria, parasites and toxins out of the body through the stool. This can make it harder to know when your child is actually getting sicker and needs more attention.
• Have your child rest in bed until symptoms subside. Do not allow your child to return to school until diarrhea has begun to improve.

DO NOT USE ANTIBIOTICS 

Viruses are by far the most common cause of gastroenteritis. Antibiotics are ineffective against viruses and may even precipitate some gastroenteritis. The decision to use antibiotics during gastroenteritis should be made by a doctor who will determine if a bacterium is the cause and only then would antibiotics be warranted.

WHEN TO SEE YOUR DOCTOR

Most cases of gastroenteritis go away on their own. Visit a doctor if the vomiting and diarrhea continues for more than a day, or if you notice any signs of dehydration like:

• Not urinating or yellow and little urine
• Dry mouth
• Crying without tears (children)
• Fever over 102 F
• Lack of energy
• Irritable(children)
• Soft spot on the top of baby’s head is sunken.
• Blood in stool, or dark tarry stool

WHAT CAN YOU DO TO PREVENT GASTROENTERITIS? 

To help prevent gastroenteritis in all members of your family, you can take the following steps:

• Wash your hands frequently with soap and water, especially after using the toilet, after changing diapers and after caring for a child with diarrhea.
• Wash your hands with soap and water before and after preparing food, especially after handling raw meat
• Wash diarrhea-soiled clothing in detergent and chlorine bleach. If bathroom surfaces are contaminated with stool, wipe them with a chlorine-based household cleaner.
• Cook all meat thoroughly before you serve it to your family, and refrigerate leftovers within two hours.
• Make sure you don’t transfer cooked foods onto unwashed plates that held raw meat.
• Wash kitchen countertops and utensils thoroughly after they have been used to prepare meat.
• Never drink unpasteurized milk or untreated water.
• If there is an outbreak in your area and you are not getting treated water then make sure that your family drinks boiled water or water treated with chlorine (bleach). They should avoid eating ice, uncooked vegetables or fruit that they haven’t peeled themselves.

Having a bout of gastroenteritis is definitely not one of the most fun times in one’s life. Knowing what to do and what not to do may be the difference between you overcoming the bout before it overcomes you or a loved one.

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