Posted on: Sunday, March 17, 2002

Prescriptions
The right fluids are key to fighting diarrhea in keiki

By Dr. Landis Lum

You wouldn't believe how many patients with stomach flu tell me they stop drinking liquids to make their diarrhea stop. This is exactly the wrong thing to do.

If you don't replace the fluids you lose, you will get seriously dehydrated and weak. Drinking more liquids will not prolong the runs. Adults and older children should drink water, tea, Gatorade and diluted sodas, and combine these with salty foods such as pretzels, saltine crackers, ramen, jook or miso soup to replace the sodium your body loses.

But if your keiki is suffering from stomach flu and is younger than 1 year old, there are some special treatment considerations.

If your keiki is limp or lethargic, go to the doctor immediately. Ditto if there is no urine for more than eight hours, no tears with crying, very dry mouth, more than eight diarrhea episodes in eight hours, or bloody diarrhea; or if the diarrhea is watery and your keiki vomits up the liquids you give him three or more times.

Adults and older kids seem to be able to correct abnormal blood levels without a lot of conscious effort. For instance, with a high-sodium condition, you get thirsty, walk to the fridge, drink more sodas or water, and dilute your blood sodium back to normal.

However, infants obviously can't do this, so they need help. But it's important to know the proper fluids to give.

You should not give a child younger than 1 any chicken broth, sodas or Gatorade. These contain the wrong amounts of electrolytes, or minerals, and your keiki can get dangerously high or low blood-sodium or potassium levels. Research has shown that chicken broth has four times the concentration of sodium proper for replacement of fluid loss, while colas, ginger ale and apple juice have just one-twenty-fifth the proper concentration.

In addition, sodas, Gatorade and juices have too much glucose, which will worsen diarrhea.

So what should you give? For bottle-fed infants younger than 1, buy special fluids that have exactly the right proportion of electrolytes, such as Infalyte, Naturalyte, Pedialyte, KaoLectrolyte or Rehydralyte. If they don't like the taste, add a small bit of Kool-Aid powder. Give them as much of this solution as they want for about four hours.

If there's vomiting, give small amounts frequently, perhaps 1 teaspoon every one to two minutes in the beginning. But by four to six hours, get back to their usual formula (don't dilute it, but if diarrhea remains severe, use a soy formula). You should also restart starchy foods with children 4 months of age and older. Try cereal, mashed potatoes, applesauce, strained bananas or rice.

You should continue giving the above special fluids until the runs stop, but you need to give only 2 to 4 ounces within a couple hours after each diarrhea episode, and half this amount after vomiting.

For breast-fed infants, continue breast-feeding, but more frequently. Supplement with the above special fluids if urine production is down.

For older kids, give extra water or half-strength Kool-Aid and bland foods, especially starches, along with pretzels or saltines for the sodium. If they refuse solids, give the above special fluids (or Pedialyte Freezer Pops if they don't like the salty taste of the fluids; you can even make these into ice pops yourself). There are no good, safe pediatric drugs for diarrhea or vomiting.

In the old days, we used to prescribe bowel rest for 24 to 48 hours, but now we know that early feedings actually reduces the duration of diarrhea by about 10 hours and improves nutrition. Even with diarrhea, the bowels can still absorb 80 to 95 percent of carbohydrates and 75 percent of the protein you eat. Just avoid fatty or rich foods, and you (and your keiki) will do just fine.

Dr. Landis Lum is a family practice physician with Kaiser Permanente, and an associate clinical professor of family and community medicine at the University of Hawai'i's John A. Burns School of Medicine.

Write: Prescriptions, 'Ohana Section, The Honolulu Advertiser, P.O. Box 3110, Honolulu, HI 96802; e-mail ohana@honoluluadvertiser.com; fax 535-8170. This column is not intended to provide medical advice; you should consult your doctor.