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Diarrhoea and Vomiting<br />
Diarrhoea and vomiting are two conditions that can occur either at the<br />
same time or separately. Viral gastroenteritis, a highly contagious infection<br />
readily spread through direct contact with an infected person or by ingesting<br />
contaminated food or water, is the most common cause of combined<br />
diarrhoea and vomiting.<br />
Diarrhoea<br />
The main symptom of diarrhoea is frequent, loose, watery bowel motions which<br />
are usually accompanied by an urgent need to go to the toilet. Abdominal pain<br />
or cramping may also occur, and sometimes nausea and/or vomiting. Common<br />
causes of diarrhoea include:<br />
• viruses (eg, norovirus, rotavirus)<br />
• bacteria – as in food poisoning – or other non-viral infections (eg, salmonella,<br />
campylobacter, giardia, E. coli)<br />
• certain medical conditions (eg, inflammatory bowel disease, coeliac disease)<br />
• diet or food intolerance (eg, spicy food, lactose in milk, too much fruit juice)<br />
• medicines (eg, antibiotics, antacids containing magnesium)<br />
• excessive alcohol.<br />
People with diarrhoea should be given fluids, preferably electrolyte replacement<br />
solutions to prevent dehydration, and anti-diarrhoeal medicines to stop or slow<br />
the diarrhoea. Refer to the pharmacist all children with diarrhoea or adults whose<br />
diarrhoea has lasted more than two days.<br />
For more information about avoiding diarrhoea while travelling (see Travel<br />
Health and Vaccinations).<br />
Rotavirus<br />
Rotavirus is a highly contagious virus of the gut which is the leading cause of<br />
severe vomiting and diarrhoea in babies and young children in New Zealand.<br />
Symptoms can range from a short period of mild, watery diarrhoea to severe<br />
dehydrating diarrhoea with vomiting, fever and shock. Before immunisation,<br />
more than 90% of all children were infected by this virus by the age of three.<br />
Rotavirus vaccine is funded on the National Immunisation Schedule (see<br />
Childhood Diseases and Immunisation: Rotavirus) and the first dose<br />
should be given before a child is 15 weeks of age.<br />
Vomiting<br />
Vomiting (throwing up) is when the contents of the stomach are forcefully<br />
expelled by the body through the mouth, usually involuntarily. Nausea is the term<br />
used to describe the feeling of being about to vomit.<br />
Common causes of vomiting include gastroenteritis, overindulgence in alcohol,<br />
food allergies, food poisoning, travel sickness, migraines, pregnancy, influenza<br />
and some medicines.<br />
Antiemetics are medicines which can be used to control vomiting, but these<br />
are only available over the counter under special circumstances (such as nausea<br />
or vomiting associated with migraine or use of the emergency contraceptive pill).<br />
TREATMENT OPTIONS<br />
Category Examples Comments<br />
Electrolyte replacement<br />
therapy (ERT)<br />
Anti-diarrhoea<br />
medications<br />
Combination products<br />
Vaccination<br />
Other<br />
Natural / herbal /<br />
supplements<br />
[GENERAL SALE]<br />
eg, Enerlyte, Ethical Nutrients Rehydrate,<br />
Gastrolyte*, Hydralyte, Pedialyte<br />
[PHARMACY ONLY MEDICINE]<br />
eg, loperamide (Diamide, Nodia,<br />
Imodium, Imodium Zapid), loperamide +<br />
simethicone (Imodium Advanced)<br />
[PHARMACY ONLY] Rapid Restore<br />
Gastro Pack (Enerlyte + Nodia)<br />
[PRESCRIPTION]<br />
eg, rotavirus vaccine (Rotarix)<br />
Lacteeze Extra Strength Chewable<br />
eg, MicroCleanz hand sanitiser<br />
Bifidobacterium lactis, Gastro Relief,<br />
Lactobacillus acidophillus, Psyllium hulls,<br />
Saccharomyces boulardii, Slippery Elm<br />
Bark, zinc<br />
Electrolyte solutions replace fluid and electrolytes and prevent dehydration. They contain sodium, potassium,<br />
glucose and citrates/bicarbonates in concentrations easily absorbed by the body. Suitable for people of all<br />
ages. Sachets must be mixed up exactly to the manufacturer’s instructions and ONLY with water. Use freshly<br />
boiled and cooled water for infants. Best given slightly chilled; the solution should be drunk in frequent small<br />
sips. Comply with expiry and storage dates on container. Different flavours available.<br />
Loperamide normalises the speed of the digestive system, helping to reduce the number and frequency of<br />
bowel motions, and restore fluid resorption. Used to temporarily stop or slow diarrhoea. Should be used in<br />
conjunction with ERT.<br />
Simethicone helps to disperse gas, relieving bloating and flatulence.<br />
Contains both Enerlyte sachets to correct and prevent dehydration and Nodia tablets to stop diarrhoea.<br />
Funded on National Immunisation Schedule for babies, first dose must be given by 15 weeks of age (see<br />
Childhood Diseases and Immunisation: Rotavirus).<br />
Lacteeze replaces the enzyme lactase in people who are lactose intolerant. Use just before eating dairy<br />
products (eg, cheese, ice cream, milk) as effects only last an hour.<br />
Hand sanitisers may be used if hygienic hand washing facilities are unavailable.<br />
Psyllium hulls are useful for both diarrhoea and constipation. The bulk fibre absorbs the extra fluid in the bowel.<br />
Some probiotics can reduce the duration of diarrhoea. Zinc can reduce the duration and severity of persistent<br />
diarrhoea in zinc-deficient children. Slippery Elm Bark can help soothe gastrointestinal irritation and normalise<br />
bowel actions. Suitable for either diarrhoea or constipation.<br />
Products with an asterisk have a detailed listing in the Diarrhoea and Vomiting section of OTC Products, on page 235.<br />
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Page 58 HEALTHCARE HANDBOOK <strong>2017</strong>-2018 Common Disorders
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