EFFECTIVE MANAGEMENT OF DIARRHEA

Diarrhea can arise from various causes, and treatment should be tailored to the underlying cause and symptoms. Here are several effective approaches to managing diarrhea:

Oral Rehydration Solutions (ORS)

Under normal digestion, the liquids containing food and digestive juices enter the small intestine as a salt solution (sodium and potassium ions). The ileum absorbs about 10% of this solution, with the rest passing into the stool, ensuring stools remain soft but not dry.

In cases of acute diarrhea, infections disrupt small intestine activity, inhibiting absorption or stimulating excessive secretion. The large intestine cannot absorb the excess fluids, leading to watery, loose stools.

Dehydration and electrolyte loss begin with the first occurrence of diarrhea. Symptoms vary by severity:

• Mild dehydration (less than 5% of body weight): Thirst.
• Moderate dehydration (5–10% of body weight): Rapid heartbeat, wrinkled skin, sunken eyes, low blood pressure, reduced urination, irritability, severe thirst.
• Severe dehydration (10% or more of body weight): Shock, coma, and potentially death.

Rehydration with fluids and electrolytes is the first essential step in treating diarrhea.

Adsorbents and Gut-Lining Protectants

Diosmectite

Diosmectite is a natural silicate clay with a high molecular weight, thin layered structure, and flexibility, allowing it to bind with proteins in the gastrointestinal mucosa. It forms a protective film over the intestinal lining, preventing diarrhea-causing agents from adhering and promoting recovery in acute diarrhea.

• Benefits:
  • Protects the gut lining.
  • Adsorbs bacterial toxins and intestinal gases.
  • Reduces bleeding at localized sites.
• Safety: Suitable for all age groups, including infants, pregnant women, and patients with liver or kidney issues, as it is not absorbed into the bloodstream.

However, Diosmectite is a supportive treatment and does not address the root cause. It should be discontinued once diarrhea resolves to avoid constipation. Avoid combining it with milk or other medications, as it may interfere with absorption.

Activated Attapulgite

Attapulgite is a magnesium aluminum silicate clay with properties similar to kaolin. Activated attapulgite is heated to enhance adsorption capabilities and is commonly used as an absorbent in diarrhea treatment.

• Mechanism: Forms a protective layer over the intestinal mucosa and adsorbs toxins and bacteria.
• Limitations: Does not address dehydration or electrolyte loss. WHO notes that its clinical significance is limited.
• Safety: Generally safe for pregnant and breastfeeding women.
• Caution: May cause constipation or phosphorus deficiency with prolonged or high doses. Not recommended for children under 6 years old.

Secretion-Reducing and Motility-Reducing Agents

Loperamide

Loperamide is a synthetic opioid that slows intestinal motility, reducing stool volume and electrolyte loss. While effective in adults, it is not suitable for children under 6 years due to potential neurotoxicity.

• Side Effects: High doses can cause constipation, abdominal pain, bloating, and rare neurological effects like headache or dizziness.
• Precautions: Avoid in cases of bacterial infections, ulcerative colitis, or during pregnancy.

Racecadotril

Racecadotril inhibits enkephalinase, reducing fluid secretion in the intestines. Unlike Loperamide, it does not affect motility, making it safer for children (from 3 months).

Probiotics

Probiotics like Lactobacillus acidophilus and Bifidobacterium restore gut flora balance, counteracting harmful bacteria.

• Mechanism:
  • Synthesize B vitamins and antimicrobial substances (e.g., lactocidin).
  • Rehydrate as freeze-dried forms, rapidly multiplying in the intestines.
  • Stimulate gut immunity (IgA production).
• Safety: A natural solution for diarrhea management, probiotics are safe for all ages with minimal side effects.

Conclusion

Combining probiotics with rehydration therapy is an effective, natural, and safe approach to managing diarrhea. These treatments not only address symptoms but also promote long-term gut health.