Vomiting and Diarrhoea
Vomiting and diarrhoea usually occur as a result of a bacterial or viral infection of the gut. Vomiting may last for 4-6 hours and loose, watery bowel motions (diarrhoea) can go on for three or more days. Stomach
pains or cramps may also occur.
The body can lose a lot of fluid through vomiting and diarrhoea, causing dehydration. Dehydration can cause serious, even life-threatening illness, especially in the very young or very old. Ask a pharmacist about suitable treatments for the family.
Causes
Viral infections of the gut - Viruses are common causes of gastroenteritis (’gastro’). The infection starts with sudden onset and often vomiting occurs before any diarrhoea. Often the first symptoms are those of a cold and perhaps a cough. In most cases the infection is short-lived, lasting 2-3 days, although diarrhoea may last a little longer.
Bacterial infections of the gut - these infections are the cause of food poisoning. Symptoms usually occur 12-48 hours after eating infected food. There is a sudden onset of frequent diarrhoea, stomach pains (often described as a ‘colicky7 pain) and vomiting.
Other infections - In some patients, especially infants and small children, diarrhoea and/ or vomiting can be a sign of serious illness, such as blood poisoning. If a child appears very unwell, or is not taking fluids orally, or there is any cause for concern, see a doctor immediately.
Chronic diarrhoea - Recurring or persistent diarrhoea may be as a result of an irritable bowel or inflammation of the bowel. See a doctor if there are frequent bouts of diarrhoea or if diarrhoea persists longer than 2-3 days. In rare cases in adults, a chronic change in bowel habit can be a sign of cancer of the gut. If this sort of change occurs, see a doctor straight away.
Medicines - Some medicines may cause diarrhoea and vomiting. Stopping some medicines may also cause diarrhoea. Those who suspect any medicines may be causing vomiting or diarrhoea should talk to a pharmacist.
Other causes - Excess alcohol and anxiety are other possible causes of diarrhoea.
IMPORTANT
See a doctor if you have diarrhoea when:
* Bowel motions contain blood.
* You are losing weight.
* It is severe with dehydration.
* It persists longer than 2-3 days - - earlier for the elderly and the very young (under two years of age).
* You have severe abdominal pain or a high fever (greater than 38°C).
Risks
* Babies, young children, the elderly and people who have chronic illnesses can become dehydrated very quickly as a result of vomiting and diarrhoea. Urgent rehydration is required, as serious or even life-threatening dehydration illness can result.
* Diarrhoea can cause some temporary damage to the bowel lining. This may make the bowel unable to cope with lactose (found in dairy products) for a short time. If dairy products make the diarrhoea worse, they should be avoided until it subsides.
Dehydration: warning signs
* More than eight runny bowel motions in 24 hours.
* Vomiting (can not keep anything down).
* Going for 10 hours or more without passing urine (2-3 hours in children).
* When the skin is pinched it stays up for a second or two.
* Irritable, sleepy or ‘floppy’ child.
* Sunken eyes or shadows under the eyes.
* ‘Soft spot’ in top of baby’s head is sunken more than usual.
* Changed breathing - either quick, or slow and deep.
* Skin feels cold and clammy.
* Dry mouth, tongue and lips, or no tears.
Rehydration
* Make up the rehydration solution exactly as listed on the packet - ask a pharmacist if unsure.
* Sip the solution whenever vomiting or a runny bowel motion occurs.
* Adults need to drink 2-3 litres of solution in 24 hours to keep hydrated. Ask a pharmacist how much to give children.
* Make up new solution every 24 hours and keep it in the fridge.
Medicines
Medicines (e.g. loperamide, diphenoxylate) are available in pharmacies for adults and children greater than 12 years of age to stop diarrhoea. Ask your pharmacist if these medicines are suitable for you. It is still important to follow the self care recommendations as well.
Self care
Babies
* Keep breastfeeding the baby, offer the breast more often, and offer rehydration solution between feeds.
* Replace other milk or formula with oral rehydration solution for 24 hours.
* Give half-strength formula for the next 24 hours, or try a lactose-free formula if necessary - ask a pharmacist.
* Sterilise babies’ bottles and dummies as well as items used to measure, mix or store made-up formula, juice or water.
* Put made-up and sterilised formula back in the fridge as quickly as possible.
* Throw away any leftover formula or milk.
Children and adults
* Use rehydration solution to replace fluids.
* After vomiting stops keep sipping fluids and eat if hungry. Avoid sweet foods. Try starchy foods e.g. rice, potatoes, bread or dry biscuits, cooked cereals, yoghurt.
* Avoid undiluted sweet/sugary drinks -they can make diarrhoea worse.
Preventing gastro
Gastro bugs can get into food (especially milk) from unwashed hands, kitchen surfaces and eating utensils. They also grow in food kept warm. Keep cooked food hot, or put it in the fridge. Insist on everyone washing their hands after going to the toilet, changing nappies, handling animals and before touching food. Other precautions should be taken when travelling (see Travel Health Fact Card).
Contact
A doctor - listed under ‘Medical Practitioners’ in the yellow pages of the phone book
Internet sites: Gastroenterological Society of Australia - www.gesa.org.au
The Gut Foundation - www.gut.nsw.edu.au
A Self Care pharmacy - to locate telephone 1300 369 772 and ask for the Pharmacy Self Care Field Officer.
In case of poisoning, phone the Poisons Information Centre on 131 126 from anywhere in Australia.
Pharmacists are medicines experts. Ask your pharmacist
for advice when choosing a medicine.
