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they are suitable to be treated at home .
Priority here is to prevent dehydration and electrolyte imbalance . This can be achieved by increasing and optimising fluid and salt intake by consuming water , juices , sports drinks , soups , and saltine crackers . Oral rehydration solution ( ORS ) should also be considered , especially in more severe cases . This is because the sugar and electrolytes in the ORS help the intestines to absorb fluids more efficiently and to correct electrolytes more effectively . ORS salt is available in most pharmacies in a pre-packaged sachet , to be mixed with water before consumption . If commercial ORS salt is not available , one can try a homemade ORS recipe : dissolve six teaspoons of sugar and a half teaspoon of salt in one litre of clean water . An adult should drink approximately three litres of ORS daily until dehydration resolves . Signs of adequate rehydration are : skin goes back normally when pinched , thirst has subsided , able to pass copious amounts of urine , and pulse is strong .
Beverages that can irritate the digestive tract , such as caffeinated or carbonated drinks and alcohol , should be avoided .
Anti-diarrhoeal medications are generally not recommended initially , as these may mask symptoms , delay diagnosis , and potentially make the digestive tract injury worse .
Antibiotics should only be considered for travel-associated diarrhoea , bloody diarrhoea , and prolonged cases of severe watery diarrhoea with fever .
If patients with acute diarrhoea do not improve after 48 hours , they should seek immediate medical attention .
Q
: When is diarrhoea a sign of a serious medical problem and what could that be ?
A
: For acute diarrhoea , the presence of the following red flag symptoms and signs for severe disease warrants immediate medical attention :
• Evidence of dehydration or shock ( tachycardia with heart rate > 100 beats per minute , systolic blood pressure < 100mmHg , weakness , confusion , inability to pass urine / significant decrease in urine volume )
• Weight loss
• Rectal bleeding
• Abdominal pain
• High fever
• Inability to maintain adequate oral intake
For chronic diarrhoea , it is important to exclude underlying organic causes , and therefore assessment by a gastroenterologist is recommended .
If symptoms and signs are ignored and left untreated , acute diarrhoea may lead to severe dehydration which may cause acute kidney injury / failure . Low blood pressure from dehydration may also lead to stroke or heart attack . Sepsis or overwhelming infection may also occur in those with bacterial gastroenteritis . All of these may lead to prolonged hospitalisation and may even be life threatening .
For chronic diarrhoea due to an organic cause , a delay in diagnosis may lead to worsening of the condition such as further bowel injury for those with inflammatory bowel disease , as well as missing the window of opportunity to intervene for those with colon cancer .
Q
: Can diarrhoea be a sign of COVID-19 ?
A
: SARS-CoV-2 , the causal agent of COVID-19 , enters human cells using the ACE2 ( angiotensin-converting enzyme 2 ) protein as a receptor . ACE2 is thus key to the infection and symptoms of COVID-19 . It is found in the respiratory and gastrointestinal tracts , thus diarrhoea may also be a manifestation of COVID-19 infection .
Published reports have shown that approximately 20 percent of COVID-19 patients have diarrhoea . It is usually associated with other COVID-19 symptoms and is rare to have diarrhoea as the only symptom .
Conversely , having diarrhoea does not imply COVID-19 infection . Nevertheless , it can serve as a warning sign , especially if there is any close contact with someone who has COVID-19 infection .
Q
: What can people do to prevent diarrhoea ?
A
: Always maintain good personal and food hygiene to minimise the risk of contracting infective gastroenteritis . Hand washing , avoiding undercooked / unhygienic / unheated stale food , and drinking clean treated water ( or bottled water in its absence ) are some examples of such good practices .
Dr Robert Lo Su Chun
Dr Robert Lo Su Chun is a gastroenterology specialist at Farrer Park Hospital , with specialty interests in liver diseases and colon cancer screening .
8 SEPTEMBER 2022 GlobalHealthAsiaPacific . com