Diarrhoea

Diarrhoea

These guidelines are written for the general information of travellers and cannot cover all possibilities. Adequate competent medical attention should always be sought. Where this is not available (e.g. trekking) then self medication and care may be necessary.

These guidelines are written for adults with no history of allergies or other serious underlying medical conditions. In all other situations you should arrange for specific guidelines from a doctor before your journey. Used sensibly these guidelines may help to lessen the severity of diarrhoea while abroad.

If you have had a significant problem while overseas always attend for medical screening on your return.

Mild Diarrhoea

Two to four loose bowel motions in 24 hours and you feel generally well. There is no fever, no blood or mucous in the motion and you are not unusually thirsty.

Increase your intake of clear clear fluids.
Use Oral Rehydration Salts (ORS) if they are available.
Flat 7-up or Coke/Pepsi are usually helpful.
Take a light diet - mainly soups etc.
Try and change your itinerary so that you can stay close to adequate facilities.
Watch for any change in your health which might suggest that the diarrhoea is becoming more serious.

Inconvenient Diarrhoea

In these circumstances your mild diarrhoea is inconvenient to your travel plans. You may need to attend an important meeting or have move from place to place. In these circumstances you still are generally well but the frequent trips to the loo are causing concern, more a social problem rather than any actual medical worry.

Follow the guidelines outlined for treating mild diarrhoea.
You may also add a drug to slow down bowel transit such as Imodium or Lomotil.
Continue to watch for signs which would suggest that the situation is becoming more serious. (See danger signs section).

Severe Diarrhoea

Under these circumstances your diarrhoea will have become very significant. Dehydration will be more evident, a temperature may have developed and mental awareness may become impaired. You must remember that severe diarrhoea can kill at any age and must always be treated very seriously. Even if vomiting is occurring small regular amounts of fluids may usually be taken by mouth and will help the situation.

Inform others and try to be obtain competent medical attention.
Ensure that plenty of clean clear fluids are taken.
Sips and teaspoons every five minutes are usually better tolerated than a full glass given less frequently.
Suck clean pure ice if possible.
Soak a piece of cloth in clean water and suck the corner. Rewet the cloth regularly.
Use Oral Rehydration sachets to replace the lost fluid. If the diarrhoea is very severe it will be difficult to overdose, otherwise just use two or three sachets per day supplemented with other fluids.
Antibiotics may sometimes need to be self administered if competent medical attention is not easily available.

Danger Signs

With diarrhoea, patients, especially children, may rapidly slip from general good health to a more severe state. Watch out for the following:

Diarrhoea 2 or 3 times each hour
Severe fluid loss through diarrhoea
Dry Tongue
Sunken eyes
Sighing breaths
Rapid pulse
Decreased mental state (confused / uncertain)
Fever greater than 100F
Blood or mucous in the bowel motion

Treatment Protocol

Check your temperature
Replace fluid loss with clean, clear fluids
Use sachets of ORS if available
Watch out for blood or mucous in the motion
Inform others if the situation is becoming more severe
Look for competent medical attention, if possible
In the more severe cases, (in patients with no history of allergy) consider using antibiotics such as Cotrimoxazole 2 tablets twice a day for 5 days or Ciprofloxacin 500mgs twice a day for 3 days.
If you are in an isolated situation try and move back to a larger town or city where medical attention is available

Notes

Many cases of mild/inconvenient diarrhoea abroad are associated with sunstroke. Take care to ensure that your fluid intake is always maintained if the climate is hot or if you are exercising significantly.

When the body perspires it excretes both water and salts. Oral Rehydration Salts (ORS) are the best way to ensure that you do not lose a significant amount of salt and potassium.

Especially remember that children are very prone to dehydration and you need to make certain that they maintain a high fluid intake under these circumstances.

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