Diarrhea: Severe with dehydration

My baby was diagnosed with the flu. Two days later, the intense, completely liquid diarrhea had not stopped, and my child was admitted to the hospital for severe dehydration as a result rotavirus. I gave my child Pedialyte at the first sign of trouble. I switched from regular baby food to rice cereal mixed with formula in the hope of finding something the baby could keep down. Nothing worked. You can only "force" a baby to drink so much, and what I could get him to drink was not enough, even though he was taking 40-50 ounces of Pedialyte each day. The diarrhea was so bad that even with that amount of fluid, he dehydrated very quickly. He ended up in the hospital for three days, on IV fluids. Admittedly, there was nothing more I could have done to ease my baby's distress, but I think it is important to stress how very dangerous this virus can be to small children.

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Robert Steele

Robert W. Steele, MD, is a board certified pediatrician at St. John's Regional Health Center in Springfield, MO. He graduated from medical... Read more

I very much appreciate your feedback, and I am certain your ordeal must have been very distressing. Your story is an important one because while diarrhea is usually easily managed at home, extreme diarrhea in infants or small children can become a very serious situation. This is seen on a daily basis in developing countries. In fact, diarrhea and dehydration is still the number one killer of infants and children in Africa, Asia, and Latin America claiming almost 3.3 million lives per year. We have substantially better statistics, however even in the U.S., diarrhea kills about 500 infants and children ranging in ages of one month to four years.

Note that I emphasize that diarrhea  is the cause of all these problems, not the infection that caused the diarrhea.  While rotavirus is a common cause of diarrhea, there are many other viruses which can cause substantial diarrhea. Some common examples include adenovirus, Norwalk virus, and astrovirus. Then there are bacteria, toxins released from bacteria, protozoans, and other parasites all of which which may cause diarrhea as well. Most of these infections do not require antibiotics, and in fact, antibiotics can make some bacterial infections worse.

Keeping up with the fluid losses is the most important thing to concentrate on during the initial phases of a diarrheal illness. This is often very difficult to do when vomiting is also a major part of the illness. Therefore, it is equally important to look for the signs of dehydration in order to know when to call your doctor. These include:

  1. Little in the way of urine. Unfortunately, it is often difficult to asses this in a child in diapers because the diarrhea may cover the entire diaper making it difficult to distinguish urine from diarrhea. However, any child who has not urinated within 12 hours during a diarrheal illness should be brought to the attention of a physician.
  2. When crying, no tears form.
  3. There isn't much saliva in the mouth, and what little is there is sticky.

Other reasons to call your doctor during a diarrheal illness include:

  1. There is blood in the stool
  2. Your child seems to be in a lot of pain
  3. Your child is lethargic or seemingly lifeless

It sounds like you did an outstanding job with your son during his illness; encouraging the proper fluids (Pedialyte), giving him as much fluid as possible, looking for signs of dehydration, and promptly taking him to the doctor when he had those signs. You should give yourself a pat on the back for doing such a fine job. Fortunately, stories like yours are uncommon, but your point is well taken. I hope I did not give the impression that diarrhea is always a minor ordeal. It certainly can be worse in some children particularly the younger they are. However, for the vast majority of people, diarrheal illness can be adequately managed at home if you know the signs of dehydration. Thank you again for your input.

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