9 min readConcept sheetOften a 10-mark answer; ORS comes as a 2-mark question

Diarrhoea and dysentery

Diarrhoea is loose, watery stools; dysentery adds blood and mucus. The first treatment is fluid and salts (ORS), then continued, light feeding.

Diarrhoea (WHO)Three or more loose or watery stools in 24 hours

DysenteryDiarrhoea with blood and mucus; bacillary (Shigella) or amoebic (Entamoeba histolytica)

Home-made ORS1 litre boiled, cooled water + 6 level teaspoons sugar + ½ level teaspoon salt

Zinc for childrenDaily zinc for 10-14 days along with ORS (WHO); the doctor sets the dose

At a glance

DiarrhoeaThree or more loose or watery stools in 24 hours (WHO)

Types by durationAcute (less than 14 days), persistent (14 days or more), chronic (more than about 4 weeks, often not infectious)

CausesInfection (rotavirus, E. coli, cholera), food poisoning, unsafe water, lactose intolerance, malabsorption, drugs such as antibiotics, IBS, anxiety

SymptomsFrequent watery stools, cramps, weakness; dehydration: thirst, dry mouth, sunken eyes, little urine

DysenteryFrequent small stools with blood and mucus, abdominal cramps, tenesmus (urge to pass stool with little output), often fever

Types of dysenteryBacillary (Shigella), sudden and with high fever; amoebic (Entamoeba histolytica), slower, may recur

Dietary principles

Nutrient	Recommendation	Why
Fluid	ORS after every loose stool plus plenty of other fluids; adults often need 3 litres or more a day	Replace water lost in stools; prevent dehydration
Sodium and potassium	ORS, salted rice kanji, buttermilk with salt, tender coconut water, banana	Both are lost in stools; low potassium causes weakness
Energy	Continue feeding; small, frequent, easily digested meals	Starving slows the healing of the gut and causes weight loss
Protein	Normal; raise in recovery with curd, moong dal, egg	Repairs the gut lining
Fat	Low; avoid fried and oily foods	Fat is poorly tolerated and can worsen loose stools
Fibre	Low residue in the acute phase; soluble fibre (banana, stewed apple, rice) is helpful	Insoluble fibre adds bulk and speeds the bowel
Lactose	Reduce milk if it worsens stools; curd and buttermilk are better tolerated	Lactase falls for a while after gut infection

ORS: what it is and how to make it

WHO low-osmolarity ORS (per litre): sodium chloride 2.6 g, glucose 13.5 g, potassium chloride 1.5 g, trisodium citrate 2.9 g; 245 mOsm/L.

1
Wash hands and boil 1 litre of drinking water; let it cool.
2★
Add one ORS packet, or for home-made ORS add 6 level teaspoons of sugar and ½ level teaspoon of salt.
3
Stir until dissolved; taste: it should be no saltier than tears.
4
Give small sips often; if the patient vomits, wait 10 minutes and continue slowly.
5
Give after every loose stool; children under 2 years 50-100 mL, 2-10 years 100-200 mL, adults as much as they want.
6
Discard any ORS left after 24 hours and make a fresh batch.

★ one-way, controls the pace

Foods to include and avoid

Food group	Include	Avoid or limit
Cereals	Rice kanji, soft rice, idli, curd rice, khichdi, toast, arrowroot	Whole-wheat bran, fried puri, bakery items with fat
Pulses	Thin moong dal, dal water	Whole gram, rajma, chana (gas-forming)
Milk	Curd, buttermilk, small amounts of diluted milk if tolerated	Large glasses of milk if they worsen stools
Vegetables and fruits	Boiled potato, bottle gourd, carrot; banana, stewed apple, pomegranate	Raw salads, cabbage, peels and seeds, unripe fruit
Fluids	ORS, tender coconut water, lemon juice with sugar and salt, rice water	Sugary soft drinks, undiluted fruit juices, coffee, alcohol
Fats and spices	Small amounts of oil; jeera and ginger	Fried snacks, chilli, heavy masala

Sample one-day menu (adult recovering from acute diarrhoea)

Meal	Menu
Early morning	ORS or tender coconut water (1 glass)
Breakfast	Idli (2-3) with thin moong dal; ripe banana
Mid-morning	Buttermilk with salt and roasted jeera
Lunch	Soft rice, thin moong dal, mashed boiled potato, curd
Evening	Stewed apple; arrowroot biscuits; weak tea
Dinner	Moong dal khichdi with curd
Bedtime	Rice kanji with a pinch of salt; ORS after every loose stool through the day

At the bedside

On the ward, keep a fluid chart: count the stools and the ORS given, and watch for signs of dehydration. Never stop food; curd rice and idli are well accepted and gentle on the gut.

Exam angle

2 marks: “What is ORS? Give its composition.” Oral rehydration solution: WHO low-osmolarity ORS per litre has NaCl 2.6 g, glucose 13.5 g, KCl 1.5 g, trisodium citrate 2.9 g. Home-made: 6 level tsp sugar + ½ level tsp salt in 1 litre water.

5 marks: “Differentiate diarrhoea and dysentery.” Definition, stool type (watery vs blood and mucus), causes, tenesmus, fever, and dietary care for each.

10 marks: “Discuss the causes, symptoms and dietary management of diarrhoea. Plan a one-day menu.” Definition and types, causes, symptoms and dehydration signs, ORS, diet principles table, foods to include and avoid, one-day menu.

Remember it

Fluids first, feed always, fat and fibre low. Home ORS = 6 sugar : ½ salt : 1 litre.