Treating Acute Diarrhea

The American Academy of Pediatrics (AAP) guidelines for care of acute gastroenteritis are based on fluid, electrolytes, and nutritional needs. Children need oral rehydration solution (ORS-commercial or homemade), additional fluids and age-appropriate foods- depending on the severity of dehydration.

Vomiting is not a contraindication for oral rehydration solution. The use of clear liquids has been refuted. Plain water can dilute the blood serum, causing hyponatremia (low sodium concentration). Liquids high in simple sugars exacerbate the osmotic effect associated with diarrhea. A usual mixed-food diet, rich in carbohydrates, may be continued and may lessen the severity and duration of the illness. Enteral nutrition actually stimulates renewal of intestinal cells, while fasting increases gut atrophy and permeability. Milk products can continue with ORS and food. The BRAT (banana, rice, apple juice or sauce, and toast) diet does not meet caloric and protein needs.

The AAP does not recommend routine use of antidiarrheal agents due to the potential for adverse effects and delayed treatment. Signs warranting medical evaluation of diarrhea include blood or pus in the stool, projectile or prolonged vomiting, abdominal distention or pain, fever, and lassitude.

(Hugger J et al. Oral rehydration therapy for children with acute diarrhea. The Nurse Practit. 1998;23(12):52-62)

Comment: School nurses can educate parents about current guidelines and their rationale.