Nutritional Management in Diarrhoea And Dysentry | CHAPTER 7 | Nutrition and Dietetics

Nutritional Management in Diarrhoea And Dysentry – This book covers the entire syllabus of “Nutrition and Dietetics” prescribed by BNMC for all Diploma in Nursing Science and Midwifery students. We tried to accommodate the latest information and topics. This book is an examination-friendly setup according to the teachers’ lectures and examination questions.

At the end of the book previous university questions are given. We hope in touch with the book students’ knowledge will be upgraded and flourish. The unique way of presentation may make your reading of the book a pleasurable experience.

Nutritional Management in Diarrhoea And Dysentry

Definition of Diarrhea:

Diarrhea, also spelled diarrhoea, is the condition of having at least three loose or liquid bowel movements each day. It often lasts for a few days and can result in dehydration due to fluid loss.

Or,

Diarrhea refers to the passage of liquid / feces and an increased frequency of defecation or it is the discharge of frequent loose stool to the rapid passages of content through the intestines.

Or,

Diarrhea is defined as the passage of loose, liquid or watery stools, more than three times per day.

Or,

Diarrhea is usually defined in epidemiological studies as the passage of three or more loose or watery stools (taking the shape of container) in a 24-hour period.

(Ref by-SN Nanjunde Gowda/24/128+ Lecture)

(Ref- K. Park’s/234/222)

Symptoms of Diarrhea:

• Increased frequency, informed and excessive liquid stools.
• Unable to control the urge to defecate.
• At times, piercing abdominal cramps associated with diarrhea.
• Stools with mucus and blood at times.
• Nausea and vomiting.
• If diarrhea persists, irritation of the anal region.
• Fluid electrolyte loss leading to fatigue, weakness, malaise.

(Ref by-SN Nanjunde Gowda/24/129)

Type of Diarrhea

A. According to duration

• Acute diarrhea (<2 weeks)
• Chronic diarrhea (<2 Weeks or longer)

B. Clinical classification

• Acute watery diarrhea (lasting for few hour to day)
• Invasive diarrhea (visible blood with stool)
• Persistent diarrhea: (<2 weeks or longer)

C. According to causative agent

• Infective
• Non-infective

D. Pathological diarrhea

• Osmotic diarrhea
• Secretory diarrhea
• Inflammatory diarrhea
• Abnormal motility

(Ref by-Davidsons/224/306)

Assessment of a Patient with Acute Diarrhea

History

• Duration and frequency of diarrhoea
• Volume of stool
• Presence of blood
• Abdominal pain
• Questioning about appropriate suspect foods
• Fever and bloody diarrhoea suggest an invasive, dysenteric process.
• Incubation periods of less than 18 hours suggest toxin-mediated food poisoning; A period longer than 5 days suggests diarrhoea caused by protozoa or helminthes
• Other systemic history : Urine output,appetite & associated illness
• Treatment history
• Drug history
• Personal history
• Family or contact history: whether family or community members have been affected & social status

Examination

• Degree of dehydration can be assessed by skin turgor, with pulse and blood pressure measurement.
• Monitoring: Urine output and ongoing stool losses.

Investigations

• Stool R/M/E: for blood and microscopy for leucocytes, and also an examination for ova, cysts and parzsites.
• Stool culture
• An FBC and serum electrolytes will also indicate the degree of inflammation and dehydration.
• In a malarious area a blood film for malaria parasites should be obtained.
• Blood and urine cultures and chest X-ray may identify alternative sites of infection, particularly if the clinical examination is suggestive of syndrome other than gastroenteritis.

Management of Diarrhea

Principle the management of acute diarrhoea.

1. Fluid replacement

2. Antibiotics/antimicrobial therapy

3. Adjunctive antidiarrheal therapy.

Fluid replacement

Replacement of established deficit.

➤ Replacement of ongoing loses.

➤ Replacement of normal daily requirement (1-1.5 liters/day).

Management of dehydration

➤ Prevention by Home-based fluids

➤ Rehydration by

a) Oral Rehydration Therapy (ORT):

• Oral Rehydration Salts (ORS)
• New Formulation

b) Intravenous rehydration:

• Initial management of severe dehydration
• Failure of ORT:

✔ Intractable vomiting

✔ High purging rate

✔ Inability to drink

• Continued Feeding
• Administration of zinc

Antimicrobial agents: According to cause

• Amoebic dysentery – Metronidazole or Tinidazole, Diloxanide furoate.
• Vibrio cholerae – Tetracycline or doxycycline
• Bacillary dysentery – Ciproflaxacin, azithromycin.

Antidiarrhoeal, antimotility and antisecretorv agents

• Not recommended in acute infective diarrhoea and their use may even be contraindicated.

(Ref by-Davidson303-4/21)

Diet Recommendation for Diarrhoeal Patient:

1. Advice to give fluids such as lime juice, salted butter milk, tender coconut water, rice porridge, weak tea with sugar, salt and sugar water, cooked dal and rice water.

2. Provide soft diet, which includes sago, flour gruel, banana, tapioca, potatoes, kichdi, dalia, beaten rice, biscuits, curd and rice.

3. Provide high pectin diet, which helps in formation of stool. High pectin diet is found in raw apple skin, apples sauce and banana.

(Ref: Onila Salin’s Essential nutrition/1/154)

Prevention of Diarrhea:

1. Breast feed the child as long as possible.

2. Use clean drinking water. Store water in clean place and cover drinking water’

3. Eat clean fresh food

4. Wash hand with soap and water before cooking, before feeding the baby and after going to toilet

5. Cover food to prevent flies seating on the food’

6. Use toilet for defecation.

(Ref: Onila Salin’s Essential nutrition/1/154-155)

Dysentery:

When loose motions are accompanied by the passage of blood and mucus, the condition is called dysentery.

Or,

Dysentery is an infectious disease associated with severe diarrhea

Or,

Dysentery is a type of gastroenteritis that results in diarrhea with blood. Other symptoms may include fever, abdominal pain, and a feeling of incomplete defecation. Complications may include dehydration

ORS

Composition of ORS:

Use of ORS:

• Correction of ‘No sign’ dehydration &
• Some sign dehydration.

RICE SALINE

Composition of Rice Saline:

Roles of ORS in diarrheal disease:

1. It has a vital role for correction of dehydration.

2. Glucose facilities absorption of Na and water in the intestine.

3. Water is required to prevent dehydration.

4. Na and K’ needed to replace the body loss of these ions during diarrhea.

5. Bicarbonate and citrate corrects acid base balance

Advantage of Rice ORS over glucose ORS:

1. Rice is cheap, easily available & more acceptable.

2. Glucose, glycine and peptide from rice enhance the absorption of sodium & water.

3. Being a polysaccharide rice starch is broken down by pancreatic amylase liberating the glucose molecules slowly, thus there does not occur an increase in the osmolality within the lumen. So osmotic problems like diarrhea and vomiting are absent during rehydration by rice based ORS solution.

After Each Loose Stool Give:

• To children less than 2 years old: ¼½ cup or glass (50-100 ml)
• To children of 2 to 10 years old: ½ cup or glass (100-200 ml).
• For children over 10 years old and adults, give as much as they want.

(Ref: Nutrition for Developing Countries/2/26)

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