Sick childby James Hubbard, M.D., M.P.H.

Many things people do or take for diarrhea and vomiting at home just make things worse. And since these are common complaints in my office, I expect they’ll be in disasters. In fact, the dehydration from vomiting and diarrhea is a major cause of death in Third World countries where getting to a doctor may be next to impossible. Children are especially vulnerable.

At the clinic where I work, we usually treat at least a couple of diarrhea/vomiting cases a week with IV fluids. But what if they’re not available? What can you take or do at home that actually will help?

Perhaps just as important, what should you not do to make things worse?

What Not to Do for Diarrhea

These things can make diarrhea worse:

  1. Over-the-counter medicines. They may decrease diarrhea for a while, but they don’t limit the time you’re going to have it. Sometimes they can make it last longer. Taking Pepto-Bismol for traveler’s diarrhea is an exception.
  2. Sports drinks. Do drink the proper fluids, starting with water. Pedialyte is ideal for children or adults. Sports drinks have too much sugar, which may make the diarrhea worse. Try diluting them 1:1 with water. Nursing babies can continue breast milk but may need extra fluids to avoid dehydration.
  3. Not eating as you’re getting better, or eating the wrong things. Replenish your strength and start the BRAT diet after the diarrhea has calmed down. That’s Bananas, Rice, Applesauce, Toast (no butter). Plain boiled potatoes and noodles are also good. But nothing else for 24 hours.
  4. Greasy foods and milk (other than breast milk). Avoid them for several days. Some people, especially children, may be unable to digest milk properly for days, even up to a month.

Finally, don’t automatically take antibiotics. Even with bacterial infections, like e. coli and salmonella, they don’t decrease the length or severity of the infection. There are exceptions, so check with your doctor for any diarrhea not letting up within 24 hours.

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What Not to Do for Vomiting

These things can make vomiting worse:

  1. Testing your tolerance. I learned this lesson when I caught a bug in college. A few minutes after vomiting, I’d try swigging some fluids because I was worried about getting dehydrated. I’d vomit them up and drink some more. I was harming myself more than I was helping. Every time I vomited I lost not only what I had drunk but also electrolytes like sodium and potassium from my stomach juices.
  2. Not letting your stomach rest. Sometimes a rest is all it takes. Wait a few hours. Then start sipping, slowly. For a baby or adult, start with a teaspoon at a time. Wait ten minutes and try another. If it doesn’t stay down, wait fifteen or twenty minutes. After a few times, increase it to two teaspoons, then four.
  3. Gulping large amounts. Avoid the temptation even if you’re thirsty. Your stomach tolerates smaller amounts better. Don’t test the limits. Remember, vomiting is worse than not drinking at all.
How to Make Your Own Dehydration Fighter

salt shakerDehydration from diarrhea is a major killer of children in Third World countries. Many can’t get medical help. That’s why the World Health Organization has come up with an Oral Rehydration Salts packet that can be dissolved in clean water. If used properly, the WHO says it can treat up to eighty percent of even the worst cases of diarrhea.

Pedialyte is a commercial version of oral rehydration salts. If you make the following homemade recipe, be sure to measure ingredients accurately. Too much sugar will make the diarrhea worse. Too much salt could be dangerous. Preferably use a measuring device. (Although the WHO thinks this is the ideal strength, if you have a question of measurement, err on the dilute side.)

Recipe for Homemade Rehydration Salts

For every quart (liter) of water add:

  • 6 level teaspoons of sugar
  • 1/2 teaspoon of salt

This version obviously lacks potassium, so you can mix in about 4 ounces of orange juice (use a teaspoon or two less of the pure sugar) or have a bite of a banana.

At least one study has shown you can substitute up to 10 teaspoons (50 ml) of honey for the sugar.

How Much to Drink

According to the World Health Organization, if you have diarrhea, you should drink the following amounts to avoid dehydration:

  • Children under two years old: ¼ to ½ cup (50-100 ml, or 2 to 3 ounces) after each loose stool, up to ½ quart (1/2 liter) per day.
  • Children two to nine: ½ cup to 1 cup (100-200 ml, or 3 to 7 ounces) after each loose stool, up to 1 quart (1 liter) per day.
  • People ten and over: as much as they want, up to 2 quarts per day.

If the person seems to be getting dehydrated, give up to 1 ounce per pound (80 ml per kg) within a four-hour period.

Signs of dehydration include:

  • Dizziness
  • Lethargy
  • Sunken eyes
  • Not tearing when crying
  • Not urinating/wetting diaper

The following are reasons to get to medical help ASAP, even if it’s difficult, since you may need IV fluids and prescription medications—sometimes even hospitalization:

  • Signs of dehydration
  • Bloody bowel movements
  • Fever over 101 F
  • Abdominal pain that doesn’t go away after a bowel movement
  • Vomiting that lasts more than a few hours
  • Diarrhea that lasts more than a day
  • The victim is a baby, chronically ill or elderly person, or diabetic

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Sick child photo © 2009 by Sean Dreilinger on Flickr.
Salt photo by Jim Forest on Flickr.