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Life Guide U.S. essentials
English

For diarrhea, first drink oral rehydration salts to replace fluid, and don't give anti-diarrhea drugs to children under 5

  • Moderate value
  • Evidence A
  • Buys life
  • Costs a little
  • Takes minutes
  • No willpower

In plain words

The most important thing in diarrhea is replacing fluid, not stopping the diarrhea. Mix oral rehydration salts (口服补液盐) with water as the instructions say and drink it; don't substitute fruit juice or soft drinks, because too much sugar actually makes you more dehydrated. Don't give anti-diarrhea drugs such as loperamide to children under 5, because in serious cases they can cause a bowel obstruction that can be fatal.

Cost

A box of oral rehydration salts costs a few to a dozen or so yuan; keep a box at home.

What you get

The World Health Organization's handbook on treating diarrhea states that “anti-diarrheal” drugs and anti-vomiting drugs have no practical benefit for acute or persistent diarrhea in children. They don't prevent dehydration and don't improve nutrition. Some have dangerous, sometimes fatal side effects and must never be given to children under 5. Drugs that slow gut movement, such as loperamide, can cause a serious paralytic ileus (bowel obstruction) that can be fatal, and can also prolong infection. The handbook also states that drinks with too much sugar draw the body's water into the gut and cause hypernatremic dehydration, such as soft drinks and commercial fruit juice drinks. The WHO handbook recommends the reduced-osmolarity formula, with a total osmolarity of 245 mOsm/L. Compared with the old formula, it cut unscheduled intravenous fluid by 33%. A Cochrane review pooling 8 trials found a similar result (OR 0.59, 95% CI 0.45–0.79, about 40% fewer).

Notes

When you buy, check the osmolarity on the insert and choose the reduced-osmolarity formula. The handbook states that if a child's stool has blood in it, it is mostly bacterial dysentery, and the child must see a doctor for antibiotics and can't be treated with fluids at home alone. The benefit is rated “medium” as a judgment: the figures at hand compare two kinds of rehydration salts, not drinking versus not drinking.

Evidence grade
A : Specific numbers from meta-analyses, large cohorts or randomized trials; for law and policy, the statute or official text.
Sources
  1. World Health Organization (2005). The treatment of diarrhoea: a manual for physicians and other senior health workers, 4th revision. https://iris.who.int/handle/10665/43209
  2. Hahn S, Kim S, Garner P (2002). Reduced osmolarity oral rehydration solution for treating dehydration caused by acute diarrhoea in children. Cochrane Database of Systematic Reviews, (1):CD002847. https://doi.org/10.1002/14651858.CD002847

Translated from the Chinese original. Original book, section 34, tip 8. This section is about health and medicines. It is general information, not a substitute for a doctor’s diagnosis or prescription. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer