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Diarrhea in practice. Case 1

Mrs Robinson asks what you can recommend for diarrhea. Her son David, aged 11 years, has diarrhoea and she is worried that her other two children, Natalie, aged 4 years, and Tom, aged just over 1 year, may also get it. David’s diarrhoea started yesterday; he went to the toilet about five times and was sick once, but has not been sick since. He has griping pains, but is generally well and quite lively. Yesterday he had pie and chips from the local takeaway during his lunch break at school. No one else in the family ate the same food. Mrs Robinson has not given him any medicine, but has some kaolin and morphine mixture at home and wants to know if David could take some, and also if the other children could take it if necessary.

Diarrhea in practice. Case 1

The pharmacist’s view

It sounds as if David has a bout of acute diarrhea, possibly caused by the food he ate yesterday during lunchtime. He has vomited once, but now the diarrhoea is the problem. The child is otherwise well. He is 11 years old, so the best plan would be to start oral rehydration with some proprietary sachets, with advice to his mother about how they should be reconstituted. Kaolin and morphine mixture should not be given to children under 12, and in any case it is not considered first-line treatment for diarrhoea. If either or both the other children get diarrhea, they can also be given some rehydration solution. David should see the doctor the day after tomorrow if his condition has not improved.

The doctor’s view

David’s diarrhoea could well be due to food poisoning. Oral rehydration is the correct treatment. He should also be told not to eat anything for the next 24 h or so until the diarrhea has settled. If he wants to drink other fluids in addition to the electrolyte mixture, he should be told to avoid milk.

His symptoms should settle down over the next few hours. If they persist or he complains of worsening abdominal pain, particularly in the lower right side of the abdomen, his mother should contact the doctor. An atypical acute appendicitis may present with symptoms of a bowel infection.

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