THE DOCTOR IS IN
OP / ED BY DR. ADIL MANZOOR
Did you know diarrhea is the third leading cause of death among children less than 5 years old? No, seriously, consider it; chances are that you as an adult have had diarrhea before, and while the condition is discomforting for a few days, it’s literally just that – discomforting. You don’t go to the toilet thinking you will die. For children, it’s different because not only can they die from it, but they actually do, in their millions.
With health concerns like this, you will be forgiven if you think it only really applies to developing countries, and not the great United States. Well, not quite. Diarrhea accounts for close to 9% of hospitalizations in the United States. And the major complication of diarrhea – dehydration – is among the top ten causes of hospitalizations in the United States. So, yes, it’s actually a problem that affects the US, too.
Now, to the actual point of this article – research has shown that diarrhea is not treated well in the US. That does not seem so surprising until you consider how simple the general treatment of the condition is, which according to the WHO is oral rehydration therapy (ORT). As I mentioned, the major threat posed by diarrhea is dehydration.
You may be reading this thinking, if dehydration is the major complication, then why not just drink water? Eh, because not only does the body lose water, but it also loses electrolytes. This is where it gets complicated.
These electrolytes are essential for a lot of functions necessary for survival, from regulating nerve and muscle function to balancing blood pressure and rebuilding damaged tissues. This also explains why when there is an electrolyte imbalance in the body, symptoms like severe lethargy, abnormal heart rate and pressure, mental disorders, convulsions, and spasms may arise.
So, to replenish the water and electrolyte content of the body, WHO has recommended ORT. This is basically one liter of water, sodium chloride (table salt), potassium chloride, sodium citrate, and glucose. In fact, some people make do with just adding salt and sugar to water – not the best but does a decent job.
Considering how simple and effective this treatment is, you will be shocked to find out that many healthcare professionals do not prescribe it nearly enough. Why?
Well, not because it is expensive, nope, not even close. Not because it is complicated to use, nope, it is quite literally just dissolving the product in water and drinking it. It’s not because it has dangerous side effects, nope, it is very safe. It is because – get this – according to research, some physicians assume their patients do not want oral rehydration salts because they aren’t “real medicines” or do not taste that good. If you’re like me, you’re thinking, when did the taste of medicine ever stop doctors from prescribing because my childhood was pretty rough in that regard?!
There are also suggestions that some pharmacists in many countries do not suggest ORT because they make more money off antibiotics. While diarrhea is often caused by bacterial infections (which can also be viral or parasitic), antibiotics are not the first line of treatment for the condition because they are simply not needed. The body does a great job of regulating its own system, and you only need to support it. Antibiotic overuse is already at dangerous levels, and it is irresponsible to start prescribing antibiotics for kids who only need ORT. That should be the message to all prescribers and physicians. That should also be the message to parents and caregivers.
When your child has diarrhea, your default thought is not to stock them up with antibiotics. You will likely be doing more harm than good in the long term if you keep at this. Instead, contact your healthcare provider, and even if they do not prescribe ORT, suggest it to them, and then use it diligently for your kid. This also works for adults, by the way.
However, if you notice there are other symptoms, like blood in the stool or diarrhea that refuses to go away after more than a week, you should definitely go back to the hospital. There may be another problem.
This article was written by Dr. Adil Manzoor, DO, a Board-Certified Internist; Board certified Pediatrician who works as a Hospitalist and Emergency Room Physician. He is also the current President of Garden State Street Medicine, a non-profit organization whose sole purpose is to provide free preventive and acute urgent care services for the homeless. He is also the co-founder of his own unique medical practice, Mobile Medicine NJ; House Call Doctors. He is also currently pursuing an Executive MBA and a Master’s of Science in Healthcare Leadership at Samuel Curtis Johnson Graduate School of Management and the Weill Cornell Graduate School of Medical Sciences.
References
- https://www.sciencedaily.com/releases/2024/02/240208142456.htm#:~:text=So%20why%20is%20it%20underprescribed%3F,-https%3A%2F%2Fwww&text=02%2F240208142456.htm-,Health%20care%20providers%20in%20developing%20countries%20know%20that%20oral%20rehydration,%2D%2D%20yet%20few%20prescribe%20it.
- https://pubmed.ncbi.nlm.nih.gov/9347004
- https://www.who.int/news-room/fact-sheets/detail/diarrhoeal-disease
