Diarrhoea and Vomiting . . .
Diarrhoea and vomiting are not diseases themselves but symptoms that can have many possible causes. Diarrhoea and vomiting can cause the body to lose a lot of fluid and dehydrate. Fluid replacement is very important for people while they are ill.
CAUSES
Acute diarrhoea and vomiting (coming on quickly and severely) are usually caused by gut infections, which lead to gastroenteritis (or 'gastro').
VIRAL INFECTIONS
Most cases of 'gastro' are caused by viral infections (e.g. norovirus). Vomiting may settle quickly in a few hours, but diarrhoea can last from 3 to 10 days.
BACTERIAL INFECTIONS
Sometimes diarrhoea and vomiting are caused by food 'poisoning' that starts about 12-48 hours after eating food contaminated with bacteria, e.g. salmonella. The bacteria may get into food (especially milk and chicken) if preparation or storage are not of a high standard.
OTHER CAUSES
Acute diarrhoea and vomiting can have other causes not related to 'gastro' infections:
• Eating too much 'rich' or greasy food.
• Drinking too much alcohol.
• Certain medicines, e.g. antibiotics.
Chronic diarrhoea (diarrhoea that keeps returning) may be due to medical conditions such as bow el disease. Pregnancy, migraines, urinary tract infections and travel sickness can cause vomiting. Vomiting in children can indicate appendicitis.
SIGNS AND SYMPTOMS
• Increased frequency of bowel movements with loose and watery stools.
• Rushing to the toilet often, with a feeling of urgency.
• Stomach cramps, flatulence (passing wind) and fever.
• Vomiting may be associated with nausea - a feeling of unease that frequently includes an upset stomach, dizziness and anxiety.
Both diarrhoea and vomiting can make you feel uncomfortable and leave you feeling weak and unwell.
RISKS
The main risk from diarrhoea and vomiting is dehydration (losing more body fluids than taken in). This is especially important for babies, young children and the elderly, who are at risk from quick and sudden fluid loss.
SIGNS OF DEHYDRATION
• Little or no urine passed for 10 hours or more (2-3 hours in babies and young children).
• Very dry mouth, tongue and lips, and no tears.
• Skin stays up when pinched.
• Sunken eyes and cheeks.
• Changed breathing - either quick, or slow and deep.
• Cold and clammy skin.
• Irritable, sleepy or 'floppy' child.
• The fontanelle (soft spot on top of baby's head) is more sunken than usual.
TREATMENT
REHYDRATION
Preventing dehydration and replacing fluids lost through diarrhoea and vomiting is the most important treatment.
• Begin fluid replacement as soon as diarrhoea or vomiting starts.
• Specially-balanced oral (by mouth) rehydration solutions are the best. They contain the right amounts of electrolytes, glucose and water to replace lost nutrients.
• If symptoms are mild, adults and children (not babies) can have diluted drinks such as juice, cordial and fizzy drinks (e.g. lemonade), or soup.
• Dilute these drinks with water. Use 5 cups of water to one cup of drink, or dilute until the drink 'only just' tastes sweet.
• Give small amounts of fluid often. Babies and children - a teaspoon every minute; adults - 1 /4 cup every 15 minutes. Large amounts at once may cause vomiting.
MEDICINES
Acute diarrhoea will usually stop on its own, within a few days. But in this period it can cause unnecessary discomfort. Medicines to control diarrhoea are available for short-term treatment. They can be used safely in adults when combined with fluid replacement and provide relief by:
• Returning bowel function and stool consistency to normal.
• Relieving stomach pain, cramps and wind pain. Medicines for nausea and vomiting are available from your doctor, and in some cases (for migraine) from your pharmacist. Talk to your Self Care pharmacist about treatment options. If after 48 hours symptoms don't improve after using medicines, or your diarrhoea gets worse, see your doctor.
IMPORTANT
See your doctor immediately if there is diarrhoea and/or vomiting with the following warning signs:
• More than 10 runny bowel motions in one day.
• Diarrhoea that for babies lasts longer than 24 hours (2 days for young children and the elderly; 3 days for older children and adults).
• Vomiting all the time, and for 24 hours or longer (3 hours for babies) unable to keep down any fluids.
• Vomit that is stained green or brown, or blood-stained.
• A high fever (body temperature over 38°C).
• Blood or mucus in bowel motions.
• Signs of dehydration.
• Severe stomach or abdominal pain. Contact your doctor straight away if anyone in your household, regardless of age:
• Has diarrhoea and vomiting and has travelled overseas recently.
• Has taken a medicine and you suspect they have had a reaction to it.
SELF CARE
Children and adults
• Use oral rehydration solutions to replace fluids. These are available from pharmacies.
• Avoid undiluted sugary drinks as their high sugar content can make diarrhoea worse.
• Eat if hungry - especially light foods such as dry biscuits, cooked mashed vegetables (e.g. potato without butter or milk), dry white toast, boiled rice and clear soup.
• If not wanting to eat, and if diarrhoea is severe, having only fluids is best. For children, food should not be stopped for longer than 24hours.
• After vomiting stops and while the stomach settles, keep sipping fluids and gradually introduce a normal diet. For a few days avoid raw fruit and vegetables, wholemeal breads, fried or spicy food and milk products such as cheese and yoghurt.
• Some medicines, e.g. the oral contraceptive pill, may not work if you get severe vomiting or diarrhoea. Discuss this with your Self Care pharmacist.
• Stay at home until your 'gastro' clears.
Babies
Continue breastfeeding your baby, and feed more often. If your baby is bottle-fed, continue feeding with full-strength formula giving small amounts often. In both cases, also give your baby oral rehydration fluid, often and in small amounts.
• Clean and sterilise the baby's bottles, teats and dummies, and items used to measure, mix and store formula milk.
• As soon as formula is made use it immediately, or store it in the fridge until required. Do not leave it out to cool.
• Throw away any milk leftover after baby has fed.
• Protect babies bottom from rash by applying after each diarrhoeal motion a protective cream (ask your Self Care pharmacist) .
PREVENTION
'Gastro' spreads very easily - through hand-to-mouth contact, after touching something that has been in contact with 'gastro' bugs from a bowel motion or from contaminated food. To help prevent the spread:
• Wash hands with soap and dry them well after going to the toilet, after changing babies' nappies, and before handling food.
• Use clean equipment for food preparation.
• Keep cooked food hot, or cool hot food immediately by placing in the fridge.
• Avoid leaving milk out of the fridge.
• Cook raw chicken very well, especially if barbequed.
• Do not store raw meat near cooked meat, and cover all foods when not being used.
• Avoid sharing food and drinks.
See www.foodsmart.org.nz for more information about food handling safety.
When travelling overseas, especially in developing countries, and away from main centres:
• Avoid eating already-peeled fruit, uncooked vegetables, cold meats, shellfish or raw seafood, unpasteurised milk, reheated food and food washed with water from the local supply.
• Avoid drinking tap water. Drink only bottled water, water that has been boiled and cooled or water purified with purifying tablets or drops. Avoid ice-cubes.
• Avoid swimming in the local water supply unless it has been treated properly.
Each 4.4g sachet of Electra! contains the active ingredients: Anhydrous glucose BP 2.7g, sodium chloride BP 0. 52g, sodium citrate BP 0.58g, potassium chloride BP 0.3g. General Sales Medicine. Electra! is used to treat and prevent dehydration in adults and children . Do not use if you have a known intolerance to any of the ingredients. Always read the label and use strictly as directed. Medicines have benefits and some may have risks. If symptoms persist, you have side effects or for further information, contact your healthcare professional. Arrow Pharmaceuticals (NZ) Ltd, Auckland.
©PHARMACEUTICAL SOCIETY OF NEW ZEALAND Inc, MAY 2011
PO Box 11640, Wellington 6142
Code PSC 0109
TAPS CH2999
CAUSES
Acute diarrhoea and vomiting (coming on quickly and severely) are usually caused by gut infections, which lead to gastroenteritis (or 'gastro').
VIRAL INFECTIONS
Most cases of 'gastro' are caused by viral infections (e.g. norovirus). Vomiting may settle quickly in a few hours, but diarrhoea can last from 3 to 10 days.
BACTERIAL INFECTIONS
Sometimes diarrhoea and vomiting are caused by food 'poisoning' that starts about 12-48 hours after eating food contaminated with bacteria, e.g. salmonella. The bacteria may get into food (especially milk and chicken) if preparation or storage are not of a high standard.
OTHER CAUSES
Acute diarrhoea and vomiting can have other causes not related to 'gastro' infections:
• Eating too much 'rich' or greasy food.
• Drinking too much alcohol.
• Certain medicines, e.g. antibiotics.
Chronic diarrhoea (diarrhoea that keeps returning) may be due to medical conditions such as bow el disease. Pregnancy, migraines, urinary tract infections and travel sickness can cause vomiting. Vomiting in children can indicate appendicitis.
SIGNS AND SYMPTOMS
• Increased frequency of bowel movements with loose and watery stools.
• Rushing to the toilet often, with a feeling of urgency.
• Stomach cramps, flatulence (passing wind) and fever.
• Vomiting may be associated with nausea - a feeling of unease that frequently includes an upset stomach, dizziness and anxiety.
Both diarrhoea and vomiting can make you feel uncomfortable and leave you feeling weak and unwell.
RISKS
The main risk from diarrhoea and vomiting is dehydration (losing more body fluids than taken in). This is especially important for babies, young children and the elderly, who are at risk from quick and sudden fluid loss.
SIGNS OF DEHYDRATION
• Little or no urine passed for 10 hours or more (2-3 hours in babies and young children).
• Very dry mouth, tongue and lips, and no tears.
• Skin stays up when pinched.
• Sunken eyes and cheeks.
• Changed breathing - either quick, or slow and deep.
• Cold and clammy skin.
• Irritable, sleepy or 'floppy' child.
• The fontanelle (soft spot on top of baby's head) is more sunken than usual.
TREATMENT
REHYDRATION
Preventing dehydration and replacing fluids lost through diarrhoea and vomiting is the most important treatment.
• Begin fluid replacement as soon as diarrhoea or vomiting starts.
• Specially-balanced oral (by mouth) rehydration solutions are the best. They contain the right amounts of electrolytes, glucose and water to replace lost nutrients.
• If symptoms are mild, adults and children (not babies) can have diluted drinks such as juice, cordial and fizzy drinks (e.g. lemonade), or soup.
• Dilute these drinks with water. Use 5 cups of water to one cup of drink, or dilute until the drink 'only just' tastes sweet.
• Give small amounts of fluid often. Babies and children - a teaspoon every minute; adults - 1 /4 cup every 15 minutes. Large amounts at once may cause vomiting.
MEDICINES
Acute diarrhoea will usually stop on its own, within a few days. But in this period it can cause unnecessary discomfort. Medicines to control diarrhoea are available for short-term treatment. They can be used safely in adults when combined with fluid replacement and provide relief by:
• Returning bowel function and stool consistency to normal.
• Relieving stomach pain, cramps and wind pain. Medicines for nausea and vomiting are available from your doctor, and in some cases (for migraine) from your pharmacist. Talk to your Self Care pharmacist about treatment options. If after 48 hours symptoms don't improve after using medicines, or your diarrhoea gets worse, see your doctor.
IMPORTANT
See your doctor immediately if there is diarrhoea and/or vomiting with the following warning signs:
• More than 10 runny bowel motions in one day.
• Diarrhoea that for babies lasts longer than 24 hours (2 days for young children and the elderly; 3 days for older children and adults).
• Vomiting all the time, and for 24 hours or longer (3 hours for babies) unable to keep down any fluids.
• Vomit that is stained green or brown, or blood-stained.
• A high fever (body temperature over 38°C).
• Blood or mucus in bowel motions.
• Signs of dehydration.
• Severe stomach or abdominal pain. Contact your doctor straight away if anyone in your household, regardless of age:
• Has diarrhoea and vomiting and has travelled overseas recently.
• Has taken a medicine and you suspect they have had a reaction to it.
SELF CARE
Children and adults
• Use oral rehydration solutions to replace fluids. These are available from pharmacies.
• Avoid undiluted sugary drinks as their high sugar content can make diarrhoea worse.
• Eat if hungry - especially light foods such as dry biscuits, cooked mashed vegetables (e.g. potato without butter or milk), dry white toast, boiled rice and clear soup.
• If not wanting to eat, and if diarrhoea is severe, having only fluids is best. For children, food should not be stopped for longer than 24hours.
• After vomiting stops and while the stomach settles, keep sipping fluids and gradually introduce a normal diet. For a few days avoid raw fruit and vegetables, wholemeal breads, fried or spicy food and milk products such as cheese and yoghurt.
• Some medicines, e.g. the oral contraceptive pill, may not work if you get severe vomiting or diarrhoea. Discuss this with your Self Care pharmacist.
• Stay at home until your 'gastro' clears.
Babies
Continue breastfeeding your baby, and feed more often. If your baby is bottle-fed, continue feeding with full-strength formula giving small amounts often. In both cases, also give your baby oral rehydration fluid, often and in small amounts.
• Clean and sterilise the baby's bottles, teats and dummies, and items used to measure, mix and store formula milk.
• As soon as formula is made use it immediately, or store it in the fridge until required. Do not leave it out to cool.
• Throw away any milk leftover after baby has fed.
• Protect babies bottom from rash by applying after each diarrhoeal motion a protective cream (ask your Self Care pharmacist) .
PREVENTION
'Gastro' spreads very easily - through hand-to-mouth contact, after touching something that has been in contact with 'gastro' bugs from a bowel motion or from contaminated food. To help prevent the spread:
• Wash hands with soap and dry them well after going to the toilet, after changing babies' nappies, and before handling food.
• Use clean equipment for food preparation.
• Keep cooked food hot, or cool hot food immediately by placing in the fridge.
• Avoid leaving milk out of the fridge.
• Cook raw chicken very well, especially if barbequed.
• Do not store raw meat near cooked meat, and cover all foods when not being used.
• Avoid sharing food and drinks.
See www.foodsmart.org.nz for more information about food handling safety.
When travelling overseas, especially in developing countries, and away from main centres:
• Avoid eating already-peeled fruit, uncooked vegetables, cold meats, shellfish or raw seafood, unpasteurised milk, reheated food and food washed with water from the local supply.
• Avoid drinking tap water. Drink only bottled water, water that has been boiled and cooled or water purified with purifying tablets or drops. Avoid ice-cubes.
• Avoid swimming in the local water supply unless it has been treated properly.
Each 4.4g sachet of Electra! contains the active ingredients: Anhydrous glucose BP 2.7g, sodium chloride BP 0. 52g, sodium citrate BP 0.58g, potassium chloride BP 0.3g. General Sales Medicine. Electra! is used to treat and prevent dehydration in adults and children . Do not use if you have a known intolerance to any of the ingredients. Always read the label and use strictly as directed. Medicines have benefits and some may have risks. If symptoms persist, you have side effects or for further information, contact your healthcare professional. Arrow Pharmaceuticals (NZ) Ltd, Auckland.
©PHARMACEUTICAL SOCIETY OF NEW ZEALAND Inc, MAY 2011
PO Box 11640, Wellington 6142
Code PSC 0109
TAPS CH2999
