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Diarrhoea and Vomiting

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

CONTINUING OTC EDUCATION As with diarrhoea, it is important to make sure the person with the vomiting does not become dehydrated. If severe dehydration develops, intravenous fluids may be needed to replace fluids lost through vomiting. If vomiting is caused by motion (see Travel Sickness), a pharmacist can advise on the best treatment for this. Dehydration The most common complication of diarrhoea or vomiting is dehydration, due to water loss through the bowel or mouth, which can be up to four times greater than usual. Important electrolytes, such as sodium and potassium, are also lost. This can be particularly serious in the very young or very old, or in people who have other illnesses, medical conditions or who take certain medicines. Since up to 75% of the body’s weight is water, signs and symptoms of dehydration can occur quickly if water is not replenished. A dry mouth or mild thirst is a sign of mild dehydration and indicates that fluid intake is already suboptimal. Initial assessment If the person with the diarrhoea or vomiting is a child or older adult, immediately ask a pharmacist to be involved in the discussion. Signs of moderate-to-severe dehydration which may require immediate medical help include: • a sunken fontanelle (soft spot on a baby’s head), sunken eyes or no tears or sweat • cold hands or feet, or mottled bluish skin • confusion (especially in the elderly) • drowsiness or “floppiness” in children, or difficulty waking them • loss of skin elasticity – it does not flatten after being pinched • passing little or no urine (or unusually dry nappies), or very dark-coloured urine. For all other customers, run through the Refer to Pharmacist questions and refer any "yes" answers. Advice for customers • Most infectious causes of diarrhoea and vomiting are easily spread. »» Regular and thorough handwashing by all household members and close contacts of the infectious person helps reduce the risk of other people becoming ill. »» Alcohol-based hand gels are useful but use in addition to hand washing not as a substitute, unless hand washing facilities are not available. • Electrolyte solutions should be drunk to help prevent dehydration because water alone will not replace electrolytes lost through diarrhoea or vomiting. • Undiluted fruit juices, soft drinks (eg, flat lemonade), sports drinks and cordials can worsen dehydration due to their high sugar content. • Mothers with sick babies who are still breastfeeding should continue with feeds as normal. Any baby that is unable to keep fluids down (whether breastfed or bottle-fed) needs to be referred to a doctor. Refer to PHARMACIST Seek immediate medical help if a person with diarrhoea or vomiting is unable to drink enough fluids to replace those lost, or if they show any symptoms of moderate-to-severe dehydration. In other non-urgent cases, ask the following specific questions and refer any “yes” answers to the pharmacist. • Does the person have any other health conditions (eg, heart or lung problems, immunosuppression, diabetes, is pregnant or breastfeeding)? • Does the person take any other medication, either prescribed by a doctor or bought from a shop or supermarket (including herbal/ complementary medications)? • Is the person elderly, frail, or a child less than five years? • Has the diarrhoea or vomiting lasted longer than 48 hours in adults or 24 hours in children? • Is the person with diarrhoea or vomiting refusing to drink fluids or is unable to keep them down? • Is there any blood or mucus in the faeces (blood may be seen as dark tarry stools)? • Does the vomit contain blood, dark brown material, or smell foul? • Are faeces pale, greasy, foul-smelling, explosive or difficult to flush? • Are there other symptoms such as severe abdominal pain, fever, vomiting or a general feeling of being unwell? • Has the person recently returned from overseas? • Is there a history of recurrent diarrhoea or constipation? • Does the person appear to be underweight? • Does the person have any allergies to medicines? • Food intake does not need to be restricted if the person feels like eating, although bland and dry foods may be preferred initially. • Be particularly careful with food hygiene, especially during the summer months and when cooking barbecues – remember to Clean, Cook, Cover, Chill. SUBSCRIBE • Latest pharmacy headlines • Online learning • Hot retail tips • Prizes & giveaways • Healthcare Handbook 09 488 4286 Page 59

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