Tuesday July 17, 2018

Diarrhea can be serious

THE RAINS have been pouring, well and good, quenching the thirst of our plants as well as lowering the still sweltering heat of a summer about to exit.

Besides a gentle rain, as long as it is not accompanied by gusty winds, is a welcome treat. However, with all the water around, water-borne infections also rise and patients suffer from its most common symptom, diarrhea.

As a starter, most people do not take diarrhea seriously. To a certain extent, they could be right because diarrhea is one form of defensive mechanism of the body to get rid of undesirable and potentially harmful even toxic substances so that they do not get absorbed into the bloodstream and cause systemic diseases. Therefore a single bout or even a repeated bout of loose bowel movement may not really be worrisome.

However, if we realize how much water there is inside our bodies, then, we pause and take a closer look at what happens if indeed, there is a protracted- continuous, unabated, uncontrolled, persistent- loose bowel movement or watery diarrhea. 55 to 65 percent of the body weight of an adult, while the water content of the body of an adult female comprises 45-55 percent of her body weight. For children and infants, 70-80 percent of their body weights is water, which explains why even a single bout of diarrhea leaves them immediately dehydrated, especially if the loose bowel movement is accompanied by nausea and emesis( vomiting) which obviously has dire consequences.

Most diarrheas (80-90 percent) result to the so-called isotonic dehydration, meaning there is an equal loss of water and electrolytes , although the very first electrolyte or ion lost is potassium, which lead to hypokalemic acidosis- that is, loss of potassium with the ph of the blood lower than the normal 7.38-7.42. Cholera El Tor is a unique type of infectious diarrhea because there is a significant loss of water much more than electrolyte loss leading to hypertonic dehydration, the blood is more viscous because of less fluid content. Your columnist clearly remembers his clerkship rotation at the San Lazaro Hospital in which cholera patients lay in cotbeds with their anus positioned on a hole underneath is a container of their loose bowel movement which is gushing like an open faucet, with four dextrose solutions inserted on both arms and legs, running at full blast. The dehydration could be so severe that all of the sudden the patient cannot speak- aphonia- a reflection of dryness of the vocal cords. Of course, the more troubling concern is the hypovolemic shock- or circulatory collapse brought about by the massive loss of body fluids firs manifested by a fast fall in blood pressure leading to other cardiovascular complications and eventual death.

Among adults, the signs and symptoms of severe diarrhea would be a fast heart rate- a compensatory mechanism to bring more blood to the tissues and cells, although a futile one,; dry parched lips, sensation of thirst. In infants, there is the sunken eyeballs, depressed fontanels, prune-like skin folds, collapsed veins which all the more make it difficult to insert an IV line.

The urgent message here is, young or old, the diarrhea must be controlled and stopped!