Talk:Diarrhea/Archive 1

This page seems to emphasize causes which are relatively severe. I does not mention the more trivial causes of the occasional diarrhea, like eating something that "disagrees with you" (such as food spicier than one is accustomed to), allergies (even as a reaction to hay fever), overindulgence in alcohol, etc. Reading this article, one would think a bout of diarrhea means something must be serious wrong with you. --Ericjs (talk) 05:24, 26 September 2008 (UTC)

adding this segment to the thorough treatment above, i would like disclose a permanently effective cure to the condition, for your consideration:

in discussing ibs, im talking about chronic diarrhea here; there are too many ways around constipation to get into here, such as highly bioavailable magnesium, probiotics, ect. it is noted here that there are cramps and a sense of constipation to be found some time before an episode of diarreah; this is because the bowel contents prior to the disturbing food were settled well, but are now very much in the way of the contents rusing upon them, creating the pressure; it strikes us as constipation because we really have to go and we dont; in truth, however, we wouldnt have the urge if something hadnt gone wrong later down the road, and the boweltransit time would emerge in due course. gas is to be expected whenever food is passing through too quickly, whether you need probiotics or not; this is often because sugar that isnt completely digested becomes food for intestinal bacteria instead; while its perfectly healthy to have this bacteria to an extent, they shouldnt be fed undigested food, as they produce gas and bloating from eating sugar/carbs like a car spits exaust from gas. so lets talk about the remedy:

calcium- you think youve tried it perhaps, but there are other considerations; if calcium isnt ionized, its no good for actually creating a high calcemic state. to get calcium in this form, from calcium carbonate say, the calcium must be hit with hcl. hcl is only produce by people with healthy adrenals, unfortunately, calcium deficient people may not have healthy adrenals, as calcium is necessary to hold electrolyes in solution. it also slows down all spasms in the body; actually, the calcium ions become so dense in what some would call a hypercalcemic state that the spasm is hard pressed to go anywhere. so how do we actually benefit from calcium? by buying an ionized form. coral calcium is recommended here. i specifically refer to one by source naturals because the particular species of coral used here doesnt contain alot of magnesium (which is a laxative. maalox is an example of a magnesium laxative.) this product contains the ideal form of vitamin d to process the calcium. this form of calcium goes directly into the bloodstream; it doesnt need to be absorbed as other forms do. there are people who need iodine to properly work with the calcium they take; iodine is necessary to work with calcium. i recommend a brand by world organics called liquid kelp. please note that sufficient levels of calcium are necessary here. ive heard of people taking 2-3 times the rda therapeutically. this hardens the stools, which then break off in smaller segments upon release. this being said, we have a way out of a condition which may be mistaken for ibs; please note that there are often nutrients lacking in ibs sufferers, such as iron, which require a longer transit time and are therefor lacking due to frequent elimination. if you have just reason to suspect iron deficiency, the form recommended here is called ferrochel; this form is double bonded and is therefore not available to be eaten by bacteria in the gi tract; consequently, it is not associated with the typical bad iron reactions, such as diarrhea, and is the only form on the market given the "generally regarded as safe" recommendation from the fda. the other form are very different. above all consult your doctor, knowing that he hasnt spent any time studing along these lines in all liklyhood. good luck to you, whoever you are —Preceding unsigned comment added by 129.170.91.138 (talk) 20:57, 29 November 2008 (UTC)

On the, 8 March 2008, some idiot named

• A glance at
  Explosive Diarrhea (note the upper case D) was created for symmetry. — RHaworth (talk · contribs
  ) 15:40, 9 November 2009 (UTC)
• Ipfreely555 would probably say that
  dire rear is another redirect only suitable for Uncyclopedia. — RHaworth (talk · contribs
  ) 23:41, 9 November 2009 (UTC)

According to Nesse and William's Evolution and healing, pp. 37-38 [1] diarrhea can be an important defense mechanism which if stopped delays illness recovery. They cite research by DuPont and Hornick ^[2] that treating Shigella with an anti-diarrhea drug (Lomotil) caused people to stay feverish twice as long as those not so treated. They cite the researchers as concluding "Lomotil may be countraindicated in shigellosis. Diarrhea may reprsent a defense mechanisms". It may be an idea to have a new section on the evolutionary medicine adaptive function of diarrhea. -There is not enough information about this subject. Please could somebody put more facts on the page. Thankyou (non member)- --LittleHow (talk) 07:43, 5 December 2008 (UTC)

Diarrhea: I would like a gastroenterologist to comment on the number of watery stools it takes to constitute (pathologic) serious diarrhea. mbc1948 —Preceding unsigned comment added by Mbc1948 (talk • contribs) 19:55, 18 August 2009 (UTC)

I searched for 'trots' and 'the trots' and I kept landing on this page. I thought it was somebody's idea of a joke until I found out that Americans think 'the trots' means diarrhoea, not 'harness racing'. I guess I'm going to teach myself how to make a disambiguation page.

Anyhow, does anybody know if any culture other than the U.S. has this meaning for 'the trots'?

MikZ (talk) 22:58, 8 July 2008 (UTC)

My grandma uses it, we live in Canada

talk

) 18:38, 15 October 2009 (UTC)

Ah, I see somebody else has created a disambiguation page now that fixes it all up. Thank you. MikZ (talk) 20:45, 12 December 2009 (UTC)

http://www.drugs.com/sfx/aspirin-side-effects.html —Preceding unsigned comment added by 64.105.0.127 (talk) 00:10, 2 August 2009 (UTC)

I think the treatment section is a bit slim. There are many medications out there for this reason. There are the C-IV drugs available by perscription or by signing at a pharmacy in some states that contain opium preparations or weak opiates for diarrhea. I think these should probably be included. Also, pain-killers are not added just for cramps, but are rather, by themselves a very powerful medication to be used for diarrhea. Loperamide is an opiate, but just does not cross the BBB. —Preceding unsigned comment added by 66.253.140.103 (talk) 00:00, 9 November 2009 (UTC)

I don't think the sentence "DIARRHEA CAN BE PAINFUL." (especially in all caps) is necessary at the end of the first paragraph; indeed, it seems more distasteful and fraudulent than anything. However, at my attempts to remove it, the edit was reverted. Perhaps the page should be protected, or...? -98.66.32.254 (talk) 18:52, 28 February 2010 (UTC)

Follow-up: this page seems to have a history of bad edits, so perhaps protecting it would be for the best. -98.66.32.254 (talk) 18:54, 28 February 2010 (UTC)

Yes this page does get alot. Will request protection.

talk · contribs · email

) 19:48, 28 February 2010 (UTC)

We need examples of diarrhea in the media and in popular discourse. Have any government officials had diarrhea in public? —Preceding unsigned comment added by 67.60.72.125 (talk) 03:15, 16 March 2010 (UTC)

To add the the gold standards that we expect from wikipedia I feel that there should be a photo of diarrhea and also a video of someone having diarrhea! 98.117.34.180 (talk) 03:10, 11 November 2009 (UTC)

They allow pictures of dead bodys so why not lol :P 11:53, 16 November 2009 (UTC) —Preceding unsigned comment added by 24.69.137.187 (talk)

Too bad about your brains not functioning. 98.246.183.207 (talk) 16:09, 17 November 2009 (UTC)

This is an example of an intelligent conversation. MeisterChief (talk) 01:56, 22 January 2010 (UTC)

LOL -- RP459 ^Talk/_{Contributions} 03:23, 22 January 2010 (UTC)

I want to know the history of diarrhea, —Preceding unsigned comment added by 121.54.35.162 (talk) 04:31, 25 January 2010 (UTC)

Yes feel free to research and write it. Google books is often a good place to start researching.

talk · contribs · email

) 19:46, 28 February 2010 (UTC)

We already mention that diarrhea might be an evolved response, not sure what else you'd say about "history" unless you find more conclusive arguments about that. —Preceding unsigned comment added by 77.2.155.91 (talk) 11:02, 7 May 2010 (UTC)

I'd define what medical people mean by explosive diarrhea too, just because it's a medical term, and people might take it the wrong way. There is a fairly accurate video available too, though I doubt we've got the rights for embedding. —Preceding unsigned comment added by 77.2.139.188 (talk) 22:23, 3 May 2010 (UTC)

Its a fake video. Plus not sure we really need that here. Frazzmatazz (talk) 11:07, 14 July 2010 (UTC)

Why is the spelling "diarrhoea" not used in the article? It should be made more prominent than just a side mention in the first line. Theoboyd (talk) 13:02, 28 May 2010 (UTC)

It is not really important how it is spelled IMO.

talk · contribs · email

) 19:18, 28 May 2010 (UTC)

I consider the spelling of diarrhoea to be incredibly important. Both spellings should be represented; IMO ideally with the English (diarrhoea) as the most prominent spelling throughout the article. Lindsay Kay (talk) 13:05, 12 July 2010 (UTC)

On Countdown, a contestant offered DIARRHOEA, and another offered DIARRHEA. The one without the O was disallowed. --Spa-Franks (talk) 17:17, 28 September 2010 (UTC)

ICD 9 uses "Diarrhea" thus we shall use this spelling.

talk · contribs · email

) 22:20, 28 September 2010 (UTC)

Well, it comes down to whether we use English English or American English. As the term English is the language of England, English English should be used. The English Dictionary COD11 uses Diarrhoea. We should use the proper spelling. Spa-Franks (talk) 20:47, 9 November 2010 (UTC)

I feel that diarrhea should be used for consistency's sake instead of intermingling the spellings throughout the article. --Devourer09 04:29, 29 September 2010 (UTC)

There seems to be little mention of clostridium difficile in the article. As a common cause of diarhoea and a healthcare acquired infection I think it perhaps deserves a greater mention and a link to the c diff wiki page would be useful. Anybody feel the same or want to write a paragraph on it? Lindsay Kay (talk) 13:12, 12 July 2010 (UTC)

Good idea...

talk · contribs · email

) 22:24, 28 September 2010 (UTC)

Should there be mention of the Bristol Stool Chart and a link to the wiki Bristol stool chart article? Is this or a similar guide used in other countries? In practice I find the Bristol Stool Chart is a useful way of classifying stool and verifying the form rather than relying solely on anecdotal evidence from patients. Use of the phrase 'loose stool' is very unhelpful as its meaning differs from one person to the next and in many UK hospitals at least the Bristol Stool Chart is used to classify stool and aid in deciding if a patient has diarrhoea or not. Type 6 and 7 are thought of as being true diarrhoea. Does it merit inclusion in the article? Lindsay Kay (talk) 13:21, 12 July 2010 (UTC)

Agree and added.

talk · contribs · email

) 22:23, 28 September 2010 (UTC)

I suggest the link from 'mushroom poisoning' is directed to http://en.wikipedia.org/wiki/Mushroom_poisoning instead of http://en.wikipedia.org/wiki/Amanita_phalloides#Symptoms. This would seem more consistent with usual Wikipedia practice. —Preceding unsigned comment added by Ihugzzz (talk • contribs) 22:18, 5 May 2011 (UTC) I believe that there shoul be a photo of diarrehia for the sake of education — Preceding unsigned comment added by 206.132.181.101 (talk) 17:22, 3 September 2011 (UTC)

• Deepak, P (2011 Sep). "Diarrhea". Disease-a-month : DM. 57 (9): 490–510.
  talk · contribs · email
  ) 08:15, 12 January 2012 (UTC)

The Treatment Of Diarrhea, A manual for physicians and other senior health workers, World Health Organization, 2005.

Page 9 (13 in PDF):
4.2.1 Rule 1: Give the child more fluids than usual, to prevent dehydration
" . . . Fluids that normally contain salt, such as:

• ORS solution
• salted drinks (e.g. salted rice water or a salted yoghurt drink)
• vegetable or chicken soup with salt.

"Teaching mothers to add salt (about 3g/l) to an unsalted drink or soup during diarrhoea is also possible, but requires a sustained educational effort.

"A home-made solution containing 3g/l of table salt (one level teaspoonful) and 18g/l of common sugar (sucrose) is effective but is not generally recommended because the recipe is often forgotten, the ingredients may not be available or too little may be given. . . "

Page 10 (14 in PDF):

" . . Give supplemental zinc" [see below, it's own section]

4.2.3 Rule 3: Continue to feed the child, to prevent malnutrition
" . . . Continued feeding also speeds the recovery of normal intestinal function, including the ability to digest and absorb various nutrients. In contrast, children whose food is restricted or diluted lose weight, have diarrhoea of longer duration, and recover intestinal function more slowly. . . "

Page 11 (15 in PDF):
" . . . Foods rich in potassium, such as bananas, green coconut water and fresh fruit juice are beneficial. . . "

4.2.4 Rule 4: Take the child to a health worker if there are signs of dehydration or other problems


4.3 Treatment Plan B: oral rehydration therapy for children with some dehydration

Page 12 (16 in PDF):
4.3.2 How to give ORS solution
" . . . Vomiting often occurs during the first hour or two of treatment, especially when children drink the solution too quickly, but this rarely prevents successful oral rehydration since most of the fluid is absorbed. After this time vomiting usually stops. If the child vomits, wait 5-10 minutes and then start giving ORS solution again, but more slowly (e.g. a spoonful every 2-3 minutes). . ."

Page 14 (18 in PDf):
" . . . Children who can drink, even poorly, should be given ORS solution by mouth until the IV drip is running. In addition, all children should start to receive some ORS solution (about 5 ml/kg/h) when they can drink without difficulty, which is usually within 3-4 hours (for infants) or 1-2 hours (for older patients). This provides additional base and potassium, which may not be adequately supplied by the IV fluid. . . "

-------------------------------------

A GUIDE ON SAFE FOOD FOR TRAVELLERS, WELCOME TO SOUTH AFRICA, HOST TO THE 2010 FIFA WORLD CUP (bottom left of page 1) .
“ . . . If ORS are not available, mix 6 teaspoons of sugar plus one level teaspoon of salt in one litre of safe water («taste of tears») and drink as indicated in the table. . . ”

Let's try and incorporate some of this into our article. Cool Nerd (talk) 22:45, 10 March 2012 (UTC)

importance of zinc

http://whqlibdoc.who.int/publications/2005/9241593180.pdf

Page 10 (14 in PDF):

"4.2.2 Rule 2: Give supplemental zinc (10 - 20 mg) to the child, every day for 10 to 14 days
Zinc can be given as a syrup or as dispersible tablets, whichever formulation is available and affordable. By giving zinc as soon as diarrhoea starts, the duration and severity of the episode as well as the risk of dehydration will be reduced. By continuing zinc supplementation for 10 to 14 days, the zinc lost during diarrhoea is fully replaced and the risk of the child having new episodes of diarrhoea in the following 2 to 3 months is reduced."

supplemental potassium

4.2 Treatment Plan A: home therapy to prevent dehydration and malnutrition

Page 11 (15 in PDF): “Foods rich in potassium, such as bananas, green coconut water and fresh fruit juice are beneficial.”

4.4 Treatment Plan C: for patients with severe dehydration

Page 14 (18 in PDF):

[As detailed in below sections, rehydration should be done modestly more slowly if the child is also malnourished.]

“In addition, all children should start to receive some ORS solution (about 5 ml/kg/h) when they can drink without difficulty, which is usually within 3-4 hours (for infants) or 1-2 hours (for older patients). This provides additional base and potassium, which may not be adequately supplied by the IV fluid.”

supplemental vitamin A

Page 25 (29 in PDF):

9.3 Vitamin A deficiency
"Diarrhoea reduces the absorption of, and increases the need for, vitamin A. In areas where bodily stores of vitamin A are often low, young children with acute or persistent diarrhoea can rapidly develop eye lesions of vitamin A deficiency (xerophthalmia) and even become blind. This is especially a problem when diarrhoea occurs during or shortly after measles, or in children who are already malnourished. . . "

general information vs. specific person, and avoiding the practice of medicine

for example . . .

The Treatment Of Diarrhea, A manual for physicians and other senior health workers, World Health Organization, 2005.
page 22 (26 in PDF):
8. MANAGEMENT OF DIARRHOEA WITH SEVERE MALNUTRITION
" . . . Signs that remain useful for assessing hydration status include: eagerness to drink (a sign of some dehydration), and lethargy, cool and moist extremities, weak or absent radial pulse, and reduced or absent urine flow (signs of severe dehydration). In children with severe malnutrition it is often impossible to distinguish reliably between some dehydration and severe dehydration. . . "

Okay, let's take the weak or absent radial pulse, well, since I AM NOT A DOCTOR, the number of sick children I have examined in a professional capacity is exactly zero. And so, if I'm holding a sick child in my arms, I cannot make a determination whether he or she has a weak radial pulse. And that I take to be the crucial line in the practice of medicine, when you move from general information, even in a good source, to a single specific patient.

As far as finding good sources, excerpting them, summarizing them, incorporating them into our article, we can do that till the cows come home. And all of it makes for a better article. But if a particular person is asking for advice, then we need to be very hands off. Now, it might seem that the safe course of action would be to say "you need to see a doctor." But I'd rather not even do that. I'd rather just say we can't give any advice to a specific person at all. Cool Nerd (talk) 20:16, 12 March 2012 (UTC)

this WHO source is excellent

It's 28 pages before the Annexes. I think about the right length and I think it gives about the right level of detail. We can excerpt and summarize. Now, it is for physicians and "other senior health workers," so some of it is not really readable, but a lot of it is readable. Cool Nerd (talk) 02:32, 10 April 2012 (UTC)

The Treatment Of Diarrhea, A manual for physicians and other senior health workers, World Health Organization, 2005

from chart on top of page 8 (12 in PDF).

Some Dehydration: restless, irritable; thirsty, drinks eagerly; use Treatment Plan B.

Severe Dehydration: lethargic or unconscious; drinks poorly or not able to drink; Use Treatment Plan C Urgently.

Treatment Plan B for 'Some' Dehydration (WHO)

Page 11 (15 in PDF):

" . . The amount may also be estimated by multiplying the child's weight in kg times 75 ml. . "

" . . . The exact amount of solution required will depend on the child's dehydration status. Children with more marked signs of dehydration, or who continue to pass frequent watery stools, will require more solution than those with less marked signs or who are not passing frequent stools. If a child wants more than the estimated amount of ORS solution, and there are no signs of over-hydration, give more. . . "

Page 12 (16 in PDF):

Table 2: Guidelines for treating children and adults with some dehydration
APPROXIMATE AMOUNT OF ORS SOLUTION TO GIVE IN THE FIRST 4 HOURS
Use the patient's age only when you do not know the weight. The approximate amount of ORS required (in ml) can also be calculated by multiplying the patient's weight in kg by 75.
NOTE: During the initial stages of therapy, while still dehydrated, adults can consume up to 750 ml per hour, if necessary, and children up to 20 ml per kg body weight per hour.

" . . . For babies, a dropper or syringe (without the needle) can be used to put small amounts of solution into the mouth. Children under 2 years of age should be offered a teaspoonful every 1-2 minutes; older children (and adults) may take frequent sips directly from the cup. . . "

pause and slow with vomiting, don’t stop:

" . . . Vomiting often occurs during the first hour or two of treatment, especially when children drink the solution too quickly, but this rarely prevents successful oral rehydration since most of the fluid is absorbed. After this time vomiting usually stops. If the child vomits, wait 5-10 minutes and then start giving ORS solution again, but more slowly (e.g. a spoonful every 2-3 minutes). . . "

page 13 (17 in PDF):

• " Breastfed infants: Continue to breastfeed as often and as long as the infant wants, even during oral rehydration.
• Non breastfed infants under 6 months of age: If using the old WHO ORS solution containing 90 mmol/L of sodium, also give 100-200ml clean water during this period. However, if using the new reduced (low) osmolarity ORS solution containing 75mmol/L of sodium, this is not necessary. After completing rehydration, resume full strength milk (or formula) feeds. Give water and other fluids usually taken by the infant. . . "

Page 14 (18 in PDF):

Begin to give food and zinc after four hour initial rehydration period:

" . . . Begin to give supplemental zinc, as in Treatment Plan A, as soon the child is able to eat following the initial four hour rehydration period. . . "

"Except for breastmilk, food should not be given during the initial four-hour rehydration period. However, children continued on Treatment Plan B longer than four hours should be given some food every 3-4 hours as described in Treatment Plan A. All children older than 6 months should be given some food before being sent home. This helps to emphasize to mothers the importance of continued feeding during diarrhoea. . . "

possible summary:

In what the World Health Organization (WHO) terms some dehydration, the child or adult is restless and irritable, is thirsty, and will drink eagerly.

The approximate amount of oral rehydration solution can be obtained by multiplying 75 milligrams of solution by the child’s weight in kilograms. Of course, the exact amount depends on how dehydrated the child is. And in general, let the person drink as much as they want as long as they drink relatively slowly. For babies, a dropper or syringe without the needle may be used. Toddlers under two should be offered a teaspoonful every 1-2 minutes. Older children and adults may take frequent sips. WHO recommends that if there is vomiting, don’t stop, but do pause for 5-10 minutes and then re-start at a slower pace. (Vomiting seldom prevents successful rehydration since most of the fluid is still absorbed. Plus, vomiting usually stops after the first one to hour hours of rehydration.) With the older WHO solution, also give some clean water during rehydration. With the newer reduced-osmolarity more dilute solution, this is not necessary.

Begin to offer food after the initial four-hour rehydration period with children and adults. With infants, continue to breastfeed even during rehydration as long as the infant will breastfeed. Begin zinc supplementation after initial four-hour rehydration to reduce severity and duration of episode. If available, zinc supplementation should be continued for 10 to 14 days.

Now, need to excerpt and summarize Plan C for Severe Dehydration. Please jump in and help if you have the time. Cool Nerd (talk) 17:38, 27 March 2012 (UTC)

Have improved and expanded actual summary in article, which happens with an ongoing project and is a good thing.  :>) Cool Nerd (talk) 20:40, 8 April 2012 (UTC)

ORS for children who are also malnourished should have less sodium, more potassium, and more sugar

http://whqlibdoc.who.int/publications/2005/9241593180.pdf from Ch 8. MANAGEMENT OF DIARRHOEA WITH SEVERE MALNUTRITION

"Full-strength ORS solution should not be used for oral or NG rehydration. It provides too much sodium and too little potassium. Two approaches to develop a suitable oral solution are possible.
When using the new ORS solution containing 75 mEq/l of sodium:

• dissolve one ORS packet into two litres of clean water (to make two litres instead of one litre);
• add 45 ml of potassium chloride solution (from stock solution containing 100g KCl/l); and
• add and dissolve 50g sucrose.

These modified solutions provide less sodium (37.5 mmol/l), more potassium (40 mmol/l) and added sugar (25g/l), each of which is appropriate for severely malnourished children with diarrhoea."---page 23 (27 in PDF)

Treatment Plan C for Severe Dehydration (WHO)

Page 14 (18 in PDF):

“The preferred treatment for children with severe dehydration is rapid intravenous rehydration, following Treatment Plan C. If possible, the child should be admitted to hospital. . . ”

“ . . . Children who can drink, even poorly, should be given ORS solution by mouth until the IV drip is running. In addition, all children should start to receive some ORS solution (about 5 ml/kg/h) when they can drink without difficulty, which is usually within 3-4 hours (for infants) or 1-2 hours (for older patients). This provides additional base and potassium, which may not be adequately supplied by the IV fluid. . . ”

Some Summary from Table 3:
For infants under one year, use an IV of Ringer’s Lactate Solution and give 30 milliliters per kilogram of body weight in the first hour. For older children and adults, give this same amount in the first half hour.

Page 15 (19 in PDF):

4.4.2 Monitoring the progress of intravenous rehydration

“Patients should be reassessed every 15-30 minutes until a strong radial pulse is present. Thereafter, they should be reassessed at least every hour to confirm that hydration is improving. If it is not, the IV drip should be given more rapidly.”

   -->   ----> However

        for children who are also severely malnourished -->  --->

"A severely malnourished child with signs suggesting severe dehydration but without a history of watery diarrhoea should be treated for septic shock."
“ . . . Rehydration should usually be by mouth; an NG tube may be used for children who drink poorly. IV infusion easily causes over-hydration and heart failure; it should be used only for the treatment of shock. . . ”---page 23 (27 in PDF) in section 8. MANAGEMENT OF DIARRHOEA WITH SEVERE MALNUTRITION

“When the planned amount of IV fluid has been given (after three hours for older patients, or six hours for infants), the child's hydration status should be reassessed fully, as shown in Table 1. . . ”

“ . . . If the child is improving (able to drink) but still shows signs of some dehydration, discontinue the IV infusion and give ORS solution for four hours, as specified in Treatment Plan B. . . ”

4.4.3 What to do if intravenous therapy is not available

"If IV therapy is not available at the facility, but can be given nearby (i.e. within 30 minutes), send the child immediately for IV treatment. If the child can drink, give the mother some ORS solution and show her how to give it to her child during the journey.

"If IV therapy is not available nearby, health workers who have been trained can give ORS solution by NG tube, at a rate of 20 ml/kg body weight per hour for six hours (total of 120 ml/kg body weight). If the abdomen becomes swollen, ORS solution should be given more slowly until it becomes less distended."

4.5 Electrolyte disturbances

“Knowing the levels of serum electrolytes rarely changes the management of children with diarrhoea. Indeed, these values are often misinterpreted, leading to inappropriate treatment. It is usually not helpful to measure serum electrolytes. The disorders described below are all adequately treated by ORT with ORS solution.”

Pages 15-16 (19-20 in PDF):

4.5.1 Hypernatraemia

"Some children with diarrhoea develop hypernatraemic dehydration, especially when given drinks that are hypertonic owing to their excessive content of sugar (e.g. soft drinks, commercial fruit drinks, too concentrated infant formula) or salt. These draw water from the child's tissues and blood into the bowel, causing the concentration of sodium in extra-cellular fluid to rise. If the solute in the drink is not fully absorbed, the water remains in the bowel, causing osmotic diarrhoea.

"Children with hypernatraemic dehydration (serum Na >150 mmol/l) have thirst that is out of proportion to other signs of dehydration. Their most serious problem is convulsions, which usually occur when the serum sodium concentration exceeds 165 mmol/l, and especially when IV therapy is given. Seizures are much less likely when hypernatraemia is treated with ORS solution, which usually causes the serum sodium concentration to become normal within 24 hours."

Page 16 (20 in PDF):

4.5.2 Hyponatraemia

"Children with diarrhoea who drink mostly water, or watery drinks that contain little salt, may develop hyponatraemia (serum Na <130 mmol/l). Hyponatraemia is especially common in children with shigellosis and in severely malnourished children with oedema. Severe hyponatraemia can be associated with lethargy and, less often, seizures. ORS solution is safe and effective therapy for nearly all children with hyponatraemia. An exception is children with oedema (see section 8), for whom ORS solution provides too much sodium."

4.5.3 Hypokalaemia

"Inadequate replacement of potassium losses during diarrhoea can lead to potassium depletion and hypokalaemia (serum K+ <3 mmol/l), especially in children with malnutrition. This can cause muscle weakness, paralytic ileus, impaired kidney function and cardiac arrhythmia. Hypokalaemia is worsened when base (bicarbonate or lactate) is given to treat acidosis without simultaneously providing potassium. Hypokalaemia can be prevented, and the potassium deficit corrected, by using ORS solution for rehydration therapy and by giving foods rich in potassium during diarrhoea and after it has stopped (see Section 4.2)."

Page 33 (37 in PDF):

ANNEX 2: ORAL AND INTRAVENOUS REHYDRATION SOLUTIONS

Reduced osmolarity ORS grams/litre
Sodium chloride 2.6
Glucose, anhydrous 13.5
Potassium chloride 1.5
Trisodium citrate, dihydrate 2.9

Page 34 (37 in PDF):

• "Ringer's Lactate Solution (also called Hartmann's Solution for Injection) is the best commercially available solution [14]. It supplies an adequate concentration of sodium and sufficient lactate (which is metabolized to bicarbonate) for the correction of acidosis. The concentration of potassium is low and there is no glucose to prevent hypoglycaemia. It can be used in all age groups for the initial treatment of severe dehydration caused by acute diarrhoea of any etiology.

• "Ringer's Lactate Solution with 5% dextrose has the added advantage of providing glucose to help prevent hypoglycaemia. If available, it is preferred to Ringer's Lactate Solution without dextrose."

"[14] In some countries special IV solutions are produced for treatment of dehydration caused by diarrhoea. These are preferred, provided they contain at least 90 mmol/L of sodium and provide base and potassium in amounts similar to those in ORS solution. The solution should also contain glucose, which helps to prevent severe hypoglycaemia."

. . a go at summarizing Cool Nerd (talk) 01:24, 2 April 2012 (UTC)

Towards summary:

In severe dehydration, the person may be lethargic or unconscious, drinks poorly, or may not be able to drink. In malnourished persons, rehydration should be performed relatively slowly by drinking or nasogastric tube unless the person is also suffering from shock in which case it should be performed quicker. In patients not malnourished, rehydration should be performed relatively rapidly by means of intravenous (IV) solution. For infants under one year of age, WHO recommends giving, within the first hour, 30 milliliters of Ringer’s Lactate Solution for each kilogram of body weight, and then, within the next five hours, 70 milliliters of Ringer’s Lactate per kilogram of body weight. For children over one year and for adults, WHO recommends, within the first half hour, 30 milliliters of Ringer’s Lactate per kilogram, and then, within the next two-and-a-half hours, 70 milliliters per kilogram of body weight. For example, if a child weighs fifteen kilograms (who is obviously over one year of age), he or she should receive 450 ml of Ringer's Lactate Solution within the first half hour, and then 1,050 ml of Ringer's Lactate within the next two-and-a-half hours. Patients who can drink, even poorly, should be given Oral Rehydration Solution (ORS) by mouth until the IV drip is running. In addition, all patients should start to receive some ORS when they are able to drink without difficulty, which is usually three to four hours for infants and one to two hours for older persons. ORS provides additional base and potassium which may not be adequately supplied by IV fluid. Ideally, patients should be reassessed every fifteen to thirty minutes until a strong radial pulse is present, and thereafter, assessed at least hourly to confirm that hydration is improving. Hopefully, patients will graduate to the ‘some dehydration’ category and receive continued treatment as above.

If IV treatment is not available at the facility, WHO recommends sending the child to a nearby facility if such can be reached within 30 minutes and providing the mother with ORS to administer to the child during the trip. If another facility is not available, ORS can be given by mouth as the child can drink or by nasogastric tube.

WHO states that knowing the levels of serum electrolytes rarely changes the treatment of children with diarrhea and dehydration, and furthermore, these values are often misinterpreted. Most electrolyte imbalances are adequately treated with ORS. For example, a child given an excess of sugar or salt such as is in commercial soft drinks, sugared fruit drinks, over-concentrated infant formula, may develop hypernatraemic dehydration. This occurs when these over-concentrated solutions sit in the gut and draw water from the rest of the body, and such children often have thirst out of proportion to other signs of dehydration. The reduced fluid in the body tissues produces a higher proportion of salt to fluid, and when serum sodium concentration is greater than 165 mmol/liter, there is a danger of convulsions. Treatment with ORS can usually bring serum sodium concentrations back to normal within twenty-four hours.

Children with diarrhea who drink mostly water or overly dilute drink with too little salt may develop hyponatraemia (serum sodium less than 130 mmol/liter). Hyponatraemia is especially common in children with shigellosis and in severely malnourished children with edema. ORS is safe and effective for nearly all children with hyponatraemia, an exception being children with edema for whom ORS provides too much sodium.

Inadequate replacement of potassium losses during diarrhea can lead to potassium depletion and hypokalaemia (low serum potassium) especially in children with malnutrition. This can potentially cause muscle weakness, impaired kidney function, and cardiac arrhythmia. Hypokalaemia is worsened when base is given to treat acidosis without simultaneously providing potassium, as happens in standard IVs including Ringer's Lactate Solution. ORS can help correct potassium deficit, as can giving foods rich in potassium during diarrhea and after it has stopped.

In WHO's THE TREATMENT OF DIARRHOEA: A manual for physicians and other senior health workers published in 2005, the recommended ORS packet consists of Sodium chloride (2.6 grams), anhydrous Glucose (13.5 grams), Potassium chloride (1.5 grams), and dihydrate Trisodium citrate (2.9 grams) with the packet to be added to one liter of water.

largely the same as including. Now working to make it even better.  :>) Cool Nerd (talk) 02:01, 10 April 2012 (UTC)

Other sources

http://rehydrate.org/

“ . . . Rehydration Project is a private, non-profit, non-sectarian, international development group. We aim to work within the health framework of developing countries to help them achieve and maintain high levels of immunization, improve access to clean water and safe sanitation, support breastfeeding and promote hygiene education. We also show these countries how to promote ORT and its effectiveness and how to develop educational programs to encourage widespread usage. In short, new ways to promote, produce and provide ORT. . . ”

"Place 6 level teaspoons of sugar and
a half level teaspoon of salt
into one litre of clean drinking water (or boiled water and then cooled)
- 1 litre = 5 cupfuls (each cup about 200 ml.)"

" . . . Be very careful to mix the correct amounts, as too much sugar can make the diarrhoea worse, and too much salt can be extremely harmful to the child. If the mixture is made a little too diluted no harm can be done and there is very little loss of effectiveness. . . "

" . . . Infants who are fed only breastmilk during the first 6 months seldom get diarrhoea. . . "

" . . . Oral rehydration therapy and continued feeding is a life-saving treatment, which only 39 per cent of children with diarrhoea in developing countries receive. Limited data show little progress since 2000. . . "

" . . . Zinc tablets are still largely unavailable in most developing countries, although their effectiveness in reducing the severity and duration of diarrhoea episodes is well known. . . "

http://www.time.com/time/magazine/article/0,9171,1914655,00.html "Can One Pill Tame the Illness No One Wants to Talk About?" [Zinc], Aug 17, 2009

The 5-Minute Pediatric Consult, 3rd Edition, Editor M. William Schwartz, 2003, p. 308: “ . . . Approximately 10% of children in the United States with acute gastroenteritis develop at least mild dehydration. . . ”

Managing Acute Gastroenteritis Among Children, CDC, MMWR, Nov. 21, 2003:

“ . . . the mechanism essential to the efficacy of ORS is the coupled transport of sodium and glucose molecules at the intestinal brush border (34) (Figure). . . ”

“ . . . However, solutions of lower osmolarity, but that maintain the 1:1 glucose to sodium ratio, perform optimally as oral solutions for diarrhea management (see Choice of ORS). . . ”

Remember, sucrose (table sugar) is a significantly bigger molecule than is sodium chloride (table salt), which might account for the home recipes for ORS. Per molecular weight, the ratio of salt to sugar is about 1:6. And thus a recipe of one teaspoon salt to six teaspoons sugar is approximately correct (in 1 liter water), although some sources only recommend half a teaspoon salt. Sources do seem to agree that solutions with either too much salt or too much sugar can cause osmotic diarrhea and make dehydration worse. Cool Nerd (talk) 20:45, 13 April 2012 (UTC)

• typographical error in "ORS should be begun at early as possible" where "at" should be "as"
• grammatical or typographical error in "Vomiting does often occurs during the first hour or two of treatment with ORS" should probably be "Vomiting often occurs ..." without the word "does"

Thank you very much for taking the time to make these improvements. Cool Nerd (talk) 18:30, 21 May 2012 (UTC)

The Treatment Of Diarrhea, A manual for physicians and other senior health workers, World Health Organization, 2005, page 9 (13 in PDF):
" . . . A home-made solution containing 3g/l of table salt (one level teaspoonful) and 18g/l of common sugar (sucrose) is effective but is not generally recommended because the recipe is often forgotten, the ingredients may not be available or too little may be given. . . "

WHO position paper on Oral Rehydration Salts to reduce mortality from cholera, World Health Organization, Global Task Force on Cholera Control:
“ . . . In case ORS packets are not available, homemade solutions consisting of either half a small spoon of salt and six level small spoons of sugar dissolved in one litre of safe water, or lightly salted rice water or even plain water may be given to PREVENT or DELAY the onset of dehydration on the way to the health facility. . . ”

So, a potential conflict between level teaspoon and "half a small spoon." Cool Nerd (talk) 19:30, 30 March 2012 (UTC)

http://rehydrate.org/
"Place 6 level teaspoons of sugar and
a half level teaspoon of salt
into one litre of clean drinking water . . . "

As this source also says:
" . . . If the mixture is made a little too diluted no harm can be done and there is very little loss of effectiveness. . . "

But, here's where we need to be very clear. It is not our job to resolve the conflict. It is our job to accurate report the current situation, including any conflicts. Cool Nerd (talk) 20:07, 30 March 2012 (UTC)

No matter conflicting opinions, there is a typo in the section From the article: "one teaspoon salt (3 grams) and two tablespoons sugar (18 grams) added[5]" should be changed to "one teaspoon salt (3 grams) and six tablespoons sugar (18 grams) added[5]". — Preceding unsigned comment added by 62.63.41.235 (talk) 04:07, 2 August 2012 (UTC)

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"Vomiting does often occurs during the first hour or two of treatment with ORS..." Someone didn't double-check the grammar. This should read "Vomiting often occurs" or "Vomiting does often occur", though the former is more academic.

132.235.82.255 (talk) 17:30, 28 June 2012 (UTC)

 Fixed Thanks. Dru of Id (talk) 17:44, 28 June 2012 (UTC)

I check pages listed in Category:Pages with incorrect ref formatting to try to fix reference errors. One of the things I do is look for content for orphaned references in wikilinked articles. I have found content for some of Diarrhea's orphans, the problem is that I found more than one version. I can't determine which (if any) is correct for this article, so I am asking for a sentient editor to look it over and copy the correct ref content into this article.

Reference named "WHOtreatmentdiarrhoea2005":

• From Management of dehydration: The Treatment Of Diarrhea, A manual for physicians and other senior health workers, World Health Organization, 2005. See “4.2 Treatment Plan A: home therapy to prevent dehydration and malnutrition,” “4.3 Treatment Plan B: oral rehydration therapy for children with some dehydration,” and “4.4 Treatment Plan C: for patients with severe dehydration” on pages 8 to 16 (12 -20 in PDF). See also “8. MANAGEMENT OF DIARRHOEA WITH SEVERE MALNUTRITION” on pages 22-24 (26-30 in PDF) and “ANNEX 2: ORAL AND INTRAVENOUS REHYDRATION SOLUTIONS” on pages 33-37 (37-41 in PDF).
• From Oral rehydration therapy: The Treatment Of Diarrhea, A manual for physicians and other senior health workers
  World Health Organization, 2005. See page 9 (13 in PDF) for home products and recipes that can be used to treat and prevent dehydration. See chapter "8. Management Of Diarrhea With Severe Malnutrition," pages 22-24 (26-28 in PDF). This manual is quite emphatic about the importance of continuing to feed the patient with page 10 (14 in PDF) stating: "Food should never be withheld and the child's usual foods should not be diluted. Breastfeeding should always be continued."

I apologize if any of the above are effectively identical; I am just a simple computer program, so I can't determine whether minor differences are significant or not. AnomieBOT⚡ 15:11, 19 August 2012 (UTC)

More information about the biological mechanisms involved would be helpful, such as duration of food in the intestines, cell damage, etc. -- Beland (talk) 18:59, 21 August 2012 (UTC)

what is the die rate in diarrhea? — Preceding unsigned comment added by 49.200.42.70 (talk) 22:05, 19 November 2012 (UTC)

Look in the section Diarrhea#Epidemeology; you may want to read more details by going to the linked WHO report. Qwyrxian (talk) 23:04, 19 November 2012 (UTC)

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For relevance and accuracy, please change the [[

Done:

Minor edit only. —KuyaBriBri^Talk

22:12, 14 January 2013 (UTC)

Thanks. UpstreamPaddler (talk) 23:03, 14 January 2013 (UTC)

When searching google for the usual spelling of diarrhoea this page does not appear. Is this another American sloppy spelling problem? Why is this strange spelling in use and how can it be altered to bring up the page in google. Does the page have perhaps the wrong title? Ianmurray5 (talk) 14:03, 25 April 2013 (UTC)

The term is spelled differently in different parts of the world.

talk · contribs · email

) (if I write on your page reply on mine) 14:11, 25 April 2013 (UTC)

Ian: This page uses the American spelling because the original version of the article did. Unless the subject of the article is particularly tied to an English speaking country, that's how we decide. (In an article on London, we would use the British spelling with the extra vowel.)

As for the "American sloppy spelling problem", you seem to be of the mistaken notion that including unpronounced letters is "proper" ("propre"? "prouper"?). That's not how we roll.

You might give a few minutes to

talk

) 15:19, 25 April 2013 (UTC)

Thanks both, I get annoyed at differences that are not sensible - like missing out a pronounced 'o' but yes OK English UK is full of both similarities and differences. It is a common problem in the UK and Australia /NZ to get Americanisms forced down our necks. However getting back to the main point, there must be a way to persuade search engines to find all common spellings of a word and redirect to one page. — Preceding unsigned comment added by Ianmurray5 (talk • contribs) 17:36, 25 April 2013 (UTC)

For me, google "Diarrhoea" brings up this article first (because

talk

) 19:02, 25 April 2013 (UTC)

Many sections mention only children, information about adults is missing. For example, the "Eating" section doesn't say whether adults should continue eating. — Preceding unsigned comment added by Israelgale (talk • contribs) 13:26, 28 August 2013 (UTC)

Hello Wikipedia, My name is Jordan, I am an undergraduate at Rice University, and I am here to propose the writing of a new Wikipedia article on Diarrhea in Developing Regions. Diarrheal diseases are among the most prolific in the world, accounting for a significant fraction of all infections, as well as a massive number of child mortalities. Given that children with diarrhea are significantly more likely to die, most within the first two years of life, Diarrheal diseases are a serious threat to the livelihood of children globally. Clearly, diarrheal disease is a significant issue in developing regions, and I hope to use this Wikipedia entry to outline the impacts of diarrheal disease, elucidate the primary causes of the issue (usually linking back to poverty and limited access to vital resources and human capabilities) and finally discuss both potential solutions and those that have already been implemented in these at-risk regions. I will draw my information from a variety of academic sources, mainly from journal articles, but also from information and data made available by some of the major organizations interested in this topic such as the CDC, and WHO. Though this page already exists on the topic of Diarrhea, it approaches the topic from a highly scientific/medical perspective which is incompatible with my approach and proposed writing on this topic, which will take a point of view more oriented around the concepts of poverty, justice and human capabilities. Another related page, Diseases of poverty, already exists, however this article approaches a number of different diseases with depth; if I were to add to this page, my content would dramatically outweigh the content on any other disease. Instead of extending on these pages, I propose the development of a new page on the topic of Diarrhea in Developing Regions, which will focus on the topics I outlined above. In order to supplement the existing articles, I plan to add small sections to these pages with a brief summary of the information that will be present on the proposed page, and add links between these three pages. Any comments, questions, or suggestions that I can use to improve my work are greatly appreciated! -- Best, Jpoles1 (talk) 20:49, 28 September 2013 (UTC)

This article deals with diarrhea generally rather than just

talk · contribs · email

) (if I write on your page reply on mine) 02:17, 30 September 2013 (UTC)

Merge with

Diarrhea in developing regions

A merge has been proposed with

talk

) 00:42, 5 November 2013 (UTC)

Suggestion

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A Cochrane systematic review published in 2013 which included 33 trials enrolling 2973 children with acute diarrhoea found that for children whose predominant source of nutrition was not beast-milk a lactose free diet resulted in quicker resulition of acute diarrhoea and reduced treatment failure. However none of the studies included on the systematic reviews were done in low-income nations where the mortality and burden of diarrhoea is highest. [3] Drsoumyadeepb (talk) 09:23, 22 November 2013 (UTC)

Will add.

talk · contribs · email

) (if I write on your page reply on mine) 11:15, 22 November 2013 (UTC)

History

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Drajay2000 (talk) 18:58, 16 January 2014 (UTC) Diarrhea is described in Ayurveda as Atisar. Acharya Charak has mentioned that it is a disease of agni i.e. digestive fire.

Not done: You have made no edit request in the form "Please replace XXX with YYY" or "Please add ZZZ between PPP and QQQ", so it is unclear what you want added.
Furthermore, you have not cited any

reliable sources to back up your request, without which no information should be added to any article. - Arjayay (talk

) 08:58, 17 January 2014 (UTC)

First it says 2004, and states a death rate, then it says two decades ago, and another death rate. Is this two decades ago from now (2014) meaning 1994? Or is it to decades ago from 2004 meaning 1984? It could be rewritten to avoid this ambiguity. Better still we should write the year 1984 or 1994 in the sentence, so it won't become incorrect if reading it a few years from now, when it will no longer be 2 decades ago. Carlwev (talk) 18:57, 19 February 2014 (UTC)

Check the ref. It is not clear.

talk · contribs · email

) (if I write on your page reply on mine) 19:28, 19 February 2014 (UTC)

It appears to be for 1980. The

talk · contribs · email

) (if I write on your page reply on mine) 21:19, 19 February 2014 (UTC)

Typo under paragraph titled "eating" should say breast-fed not feedWutang101 (talk) 15:09, 22 February 2014 (UTC)

Thanks and done.

talk · contribs · email

) (if I write on your page reply on mine) 16:35, 22 February 2014 (UTC)

1. The British variant, "diarrhœa", should probably be changed to "diarrhoea", cf. e.g. this with this—it doesn't seem to be about technical limitations, it's rather the Latin ligatures having fallen out of use.

2. In the last sentence, the semicolon after "breastfed" should be replaced by a comma. 37.190.148.74 (talk) 00:04, 27 June 2014 (UTC)

Done Thanks

talk · contribs · email

) (if I write on your page reply on mine) 07:26, 27 June 2014 (UTC)

Make link to environmental enteropathy article ?

I think we need to make a link to the (new)

talk

) 22:51, 10 January 2015 (UTC)

Semi-protected edit request on 10 March 2014

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Can we please link to Open defecation within the article?

Thanks wiki gang!

C

Cbosh88 (talk) 09:40, 10 March 2014 (UTC)

Not done: it's not clear what changes you want made. Please mention the specific changes in a "change X to Y" format. — {{U|Technical 13}} ^{(t • e • c)} 13:08, 10 March 2014 (UTC)

Done. Have added the links to open defecation and lack of sanitation which were clearly missing from the prevention section.

talk

) 22:52, 10 January 2015 (UTC)

Should we merge the content of the article

Yes the merge has been proposed for a good year. Have begun merging. Doc James (talk · contribs · email) 00:43, 12 January 2015 (UTC)

Good. You had written on the other talk page: This content is really about infectious diarrhea rather than diarrhea generally. More work will need to be done. What do you mean by this? Do we need a separate page from infectious diarrhea? Should the title of the article be changed? What other types of diarrhea are there apart from the infectious diarrhea (I guess the other types are when the diarrhea is a symptom of another disease e.g. HIV/AIDS or side effects of treatments (e.g. chemotherapy) or whatever.

talk

) 08:52, 12 January 2015 (UTC)

We already have an article on

infectious diarrhea which is known as gastroenteritis

.

One can get diarrhea from drinking to much fruit juice for example. Fairly common in children. Doc James (talk · contribs · email) 09:15, 12 January 2015 (UTC)

Then we need to put something into the lead to make it clear how this differs from gastroenteritis (as far as I could see, gastroenteritis is so far not mentioned once in the article). And include an explanation of the other types of diahrrea in the article? In the literature in the WASH sector we normally always speak of diarrhoea, not about gastroenteritis.

talk

) 10:00, 12 January 2015 (UTC)

Mentioned in the first sentence of the second paragraph of the lead. Added it down in the differential diagnosis section as well. Doc James (talk · contribs · email) 10:08, 12 January 2015 (UTC)

Under the "Management" section, this sentence, "To the contrary, WHO recommends that children with diarrhea continue to eat as sufficient nutrients are usually still absorbed to support continued growth and weight gain and that continuing to eat speeds also recovery of normal intestinal functioning." The words "also" and "speeds" need to be switched for the sentence to make sense. I also think that there should be a comma after "continue to eat."

There are some more semantic improvements I'd like to see here, but it would be too lengthy to write. How does one go about getting an authorized account for things like this anyways?

Yes, please make such improvements. Are you not able to edit the page (I am not sure, is it a protected page?)? Are you getting an error message?

talk

) 17:48, 20 January 2015 (UTC)

@

WP:SIGN your posts in a discussion. Regards, kashmiri ^TALK

18:22, 20 January 2015 (UTC)