Slide 3
Recognising dehydration and why it is important
Q. Is Suki's mother right to ask for injections and capsules to treat his
diarrhoea? What is the meaning of the red cross over the medicines in this
slide?
A. Suki's mother is right to ask for treatment but she is not right to ask
for injections and capsules. The red cross is trying to show you that medicines
are not good treatment for diarrhoea. Now look at the other half of the slide,
which summarises why the medicines do not help.
Try to answer these
questions:-
Q. What is the cause of death when a child dies from diarrhoea? What then, is
the treatment that can prevent death?
A. The cause of death from diarrhoea is dehydration, that is, loss of water from
the body. Infection may cause the diarrhoea, but the does not cause death.
Usually, after a few days, your body overcomes the infection, and the diarrhoea
stops by itself. We say that the problem is self -limiting and medicines
do not help. Only the dehydration is dangerous. So, to prevent death from
diarrhoea, replace the lost water. Suki might die if you give him an injection,
but forget to give him water. Replacing the lost water is called rehydration.
Teacher's Note
If proprietary and indigenous diarrhoea medicines are still widely used in
your area, you may find much resistance to these ideas, and it may help to stop
and discuss the value and dangers of familiar, locally used proprietary
diarrhoea medicines. Compare the needs of and dangers to adults and children.
There is some additional material in the "Further Discussion" section. |
Further Discussion (not recorded)
See how many of the brand names in the picture of the medicines you
recognise. Try to find out the composition of the brands that are available
where you work (some examples appear below). Also, try to find out how they are
supposed to cure diarrhoea. Some of these medicines contain drugs which paralyse
the intestine (e.g. diphenoxylate, morphine, codeine). -They are also called
"antimotility" drugs. 'This may stop the stools coming out (so they
may help an adult to complete a bus ride home), but they do not stop a child
losing fluid.
The fluid collects in the intestine and a child can still die from dehydration
even though his diarrhoea has 'stopped'. Probably, however, recovery is quicker
if the stools and the infective agent are passed out as soon as possible. Also,
all the antimotility drugs are toxic.
Some medicines contain kaolin, which is a kind of chalk, which is supposed to
make the stools hard by "cementing" them. Again, it does not prevent
fluid loss.
Some diarrhoea is due to the bowel secreting, that is, actively pouring out,
extra fluid. Some "antisecretory" drugs may be available in the
future. But it is dangerous if nurses and mothers give a drug and forget to give
the extra fluids and special drinks which are most important in
diarrhoea.
Some medicines contain antibacterial agents. If the diarrhoea is due to a
bacterial infection in the intestine, then it is logical to use these medicines.
In most bacterial diarrhoeas experience has shown that antibiotics do not cure
the diarrhoea any faster than your body left to
itself. In acute dysentery, diarrhoea with blood and pus in the stools,
antibiotics are valuable. But many infections are due to viruses, against which
antibacterials are powerless. Some antibiotics and antibacterials are positively
harmful. They kill off 'normal' symbiotic bacteria, which are part of the body's
defence mechanism, and this allows pathogens to persist, prolonging carrier
states. Some medicines actually damage the gut wall.
If diarrhoea is due to amoeba or giardia, then these infections must be properly
diagnosed and specific treatment must be given. Sometimes diarrhoea is due to
infection which affects other parts of the body like the middle
ear-otitis media. In this case, also, the cause must be correctly diagnosed and
the specific treatment given. (This may be the appropriate antibiotic.)
Proprietary diarrhoea medicines are not useful for these kinds of diarrhoea
either.
Examples
|
Proprietary Name |
Generic Name |
Action |
|
"Lomotil" |
diphenoxylate-hydrochloride and atropine sulphate |
antimotility |
|
"Guanimycin" |
dihydrostreptomycin, sulphaguanidine and kaolin |
anti-bacterial and stool thickener |
|
"Kaopectate" |
kaolin |
stool thickener |
|
"Kaodene" |
codeine and kaolin |
antimotility and antisecretory |
|
"Imodium" |
loperamide |
antimotility |
