Children's Health Specialists

Drs Gioia, Irri & Krishnan

Health Central, Suite 201
37 West Garden Street
Auburn, NY 13021 AND 27 Fennel Street, Skaneateles, NY 13152
315-253-6257 fax 315 253 8693
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THE CARE OF GASTROENTERITIS

The Disease

Symptoms are throwing up, loss of appetite, and loose watery and frequent bowel movements with painful cramps; these symptoms are usually caused by an infection.

The germs, viruses or bacteria, infect the intestines or bowels and irritate them. This causes the digestive system to stop or slow down and to cramp. The infection is called gastroenteritis.

The most common infections in our area which cause the vomiting and diarrhea are viruses. There are currently few medicines that fight viruses and none for intestinal viruses. Even if bacteria cause the gastroenteritis, the medicines that fight bacteria such as penicillin and sulfa drugs usually only make the disease worse. Hamburger meat often has bacteria in it. Be sure center of hamburger is cooked well.

An exception is campylobacter fetus jejuni (formerly vibrio fetus jejuni). These bacteria are carried by livestock such as cows and goats and by puppies and kittens. These bacteria often cause bloody diarrhea and fever. In this case treatment with erythromycin helps. For other germs the erythromycin would make the disease worse.

There are other less common bacteria or parasites that cause gastroenteritis and may be treated . Salmonella may come from uncooked eggs or chicken or from pet iguanas. Shigella is commonly spread among preschoolers especially in large groups such as in daycare centers. Giardia is a one cell animal that lives in the intestines of animals and humans. It is spread easily in daycare and may also be spread in contaminated water. Cryptosporidiosis is also a one cell animal which may also be spread by contaminated water. It has no treatment but it severly affects only people who have immune problems. Presently research is being done on dinoflagellates as a cause of disease from water. To prevent disease from contaminated water you may consult John Tomandl for water treatment.

Usually at the beginning of the infection there is vomiting which lasts one to three days; the diarrhea begins soon after and may continue for two weeks.

Dehydration

The biggest danger with gastroenteritis is that the vomiting and diarrhea will cause excessive water loss and the patient may dry out or dehydrate. Our body is 70 percent water which is necessary for blood flow and body functions. When the patient is urinating regularly, at least twice a day, then there is probably enough water in the body.

Treatment

To prevent dehydration it is best to give the patient a simple mixture of water, sugar and salt. In this way, the water is best taken in and retained. Foods tend to make the irritation of the bowels worse and cause further water loss. Fruit juices also loosen the stools and should be avoided.

        The  best mixture of water,  sugar and salt to replace the losses

        of vomiting and diarrhea is:

                          20 ounces water

                          1/4 teaspoon salt

                          1 to 1 1/2 tablespoon sugar

         This is called the oral electrolyte solution and is used for

         Oral Rehydration Therapy or  ORT .

        Commercially, this preparation is sold as Pedialyte or Infalyte.

If the patient is old enough (6 months or older) to have had juices or punch, the oral electrolyte solution may be flavored with those other drinks. The proportion should be one-eighth juice or punch to seven-eighths electrolyte solution. When the patient is vomiting often just start with 1 tablespoon of the solution every 20 minutes and increase gradually as tolerated.

If the patient is on breast milk, then breast-feeding may be tried. If the patient vomits the breast milk, then the oral electrolyte solution should be used again.

If the patient is on a formula, then once the patient is keeping down the solution well, a soy formula such as Prosobee, Isomil, or Nursoy feedings may be tried. These soybean-based formulas lack lactose and therefore cause less diarrhea in the sick patient. Lactofree formula may also be used. When the regular formula or cow's milk is restarted, the diarrhea may begin again. For best results, try the formula or cow's milk for only 2 feedings per day for 2 days before using it for all feedings. For children over 9 months old 1 to 2 teaspoons of yogurt with acidophilus each day may help get the intestines back to normal.

For the older patient who has eaten many solid foods, ripe bananas, rice cereal, boiled rice, cooked apples without the skins, and cooked carrots may be tried once the oral electrolyte solution has been taken well. Lactaid milk or reduced lactose milk may be used until diarrhea is gone. These foods help to firm up the bowel movements.

For the patient over one year old, clear broth, crackers, toast, and hard cheeses may also be tried once the solution has been taken eagerly without vomiting. Kaopectate (1 tablespoon, three times a day), or Imodium AD (1/2 teaspoon 3 times a day) may help slow the diarrhea.

Signs of Danger

 Call the doctor if:

           -- the patient does not urinate at least twice daily;

           -- there is a large amount of blood in the bowel movements;

           -- the  patient has a fever (temperature over 101  degrees

                  rectal) for more than one day;

           -- there  is constant abdominal pain  lasting more than  4

                  hours. (This might be a sign of appendicitis)

           -- there is a stiff neck or bleeding under the skin

           -- the patient is less than 2 months old.

           -- the patient has vomiting for more than 12 hours straight