DIARRHOEA AND VOMITING

THERE are simple principles to observe when dealing with diarrhoea and vomiting. It is most important that the patient doesn't get dehydrated. This is most likely to happen when both diarrhoea and vomiting occur together, when the patient is very young, very old and/or frail and when the symptoms have been going on for a while. If the patient is unable or unwilling to drink then they are likely to get worse more quickly.

WHEN to call.

• WHEN  the patient is under six months and has had three or more diarrhoea filled nappies or has diarrhoea and vomiting. Also, the refusal to feed can be serious in this age group and warrants a call for advice.
• WHEN the patient is elderly(75+) and/or frail.
• WHEN the patient has had numerous bouts of diarrhoea and vomiting over a 24 hour period and despite treatment is no better.
• WHEN the patient hasn't passed urine for over 24 hours (12 hours in children or older patients).
• WHEN the patient cannot or will not drink..
• WHEN the patient has other symptoms - esp. dizziness, faintness or high fever (39+)
• WHEN there is continuous moderate > severe pain.
• IF you are concerned that it may be more than a bout of D&V in a fit adult and need more advice.

ALTHOUGH not necessarily as an emergency ALL FOOD-HANDLERS and HEALTH-CARE WORKERS should report bouts of diarrhoea and vomiting to us so that we can arrange for appropriate samples to be sent off. The must be clear of bugs such as salmonella etc. before you can return to work.

TREATMENT consists of rehydration - preferably with a salt and sugar solution such as DIORALYTE if there is diarrhoea. Liquid needs to be taken liberally to replace losses (if there is a temperature these will be even higher). The best guide that fluid replacement is adequate is a good output of urine which isn't too dark and concentrated.

WHAT about food? This is always a vexed question - especially with children who are feeling very hungry. It is best to avoid food initially - especially dairy-based food and milk. Non-dairy food can be cautiously introduced after 12 to 24 hours if the symptoms are settling well.

FAILURE to respond to treatment after 24 hrs. or recurrence warrants a call for further advice.

HYGIENE is very important to prevent spread. Patients should be scrupulous about hand-washing and should have their own towel etc. Close physical contact is best avoided in the acute phase of the illness.

SCHOOL. Infants who cannot look after their own hygiene should be kept off. If the child is not especially unwell in themselves and can understand and carry out simple hygiene measures such as hand-washing then they can if the school agrees attend.

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