Diarrhoea (Dast): ORS, Zinc, Probiotics and When to Worry

Loose motions (dast, pait kharab) are one of the commonest illnesses in Pakistan, and one of the commonest causes of death in young children. Most episodes are mild and settle at home within a few days. The danger is not the diarrhoea itself but the loss of water and salts, which can lead to dehydration quickly, especially in babies, young children and the elderly.

This guide explains the correct way to treat diarrhoea, how and why to use ORS and zinc, when probiotics and anti-diarrhoeal medicines help (and when they should not be used), the myths to avoid, and the warning signs that need urgent medical care.

What causes diarrhoea?

• Viral infections such as rotavirus and norovirus, the most common causes, especially in children.
• Bacterial infections from contaminated food and water, including E. coli, salmonella, shigella, campylobacter and cholera.
• Parasites such as giardia and amoeba. See our guide to intestinal worms and deworming.
• Food poisoning, and traveller’s diarrhoea.
• Antibiotics, lactose intolerance, irritable bowel, and other medicines or illnesses.

Diarrhoea means three or more loose, watery stools in a day. Acute diarrhoea lasts less than two weeks, and persistent diarrhoea longer than that.

The most important treatment: fluids and ORS

Oral rehydration solution (ORS) is the single most important treatment for diarrhoea, and it has saved millions of lives. It contains the right balance of salts and sugar to be absorbed by the gut and replace what is lost. Plain water, juice, soft drinks and tea are not good substitutes.

• Use ready-made sachets or liquid ORS. Options at Khasmart include Peditral ORS, Peditral Liquid, Orl ORS, Rehydramin, Maclyte and Hydraden.
• Mix exactly as the pack says, with safe, clean water that has been boiled and cooled. Too little water makes it too strong, and too much makes it ineffective. Do not add sugar, salt or anything else.
• Give small, frequent sips, a teaspoon every minute for a young child, and more after each loose stool. If your child vomits, wait ten minutes and continue slowly.
• Use mixed ORS within 24 hours and discard the rest.
• Continue until the diarrhoea stops.

You can also read our guide to nausea and vomiting.

Zinc for children

For children under five, the World Health Organization advises zinc along with ORS for 10 to 14 days. It shortens the illness, reduces the severity, and lowers the chance of new episodes in the next few months. Ask your doctor or pharmacist for a suitable zinc product and the right amount for your child’s age.

Feeding during diarrhoea

• Do not stop feeding. Continue breast milk or formula, and offer more often. See our guides to formula milk and breastfeeding.
• For older children and adults, give usual, easily digested food as soon as they can eat: khichdi, rice, boiled potato, banana, toast, dahi, daal soup and chicken broth.
• Avoid very oily, spicy and sugary foods, and fizzy drinks, until recovered.
• Give an extra meal a day for a week after recovery to catch up.

Probiotics

Some probiotics may shorten diarrhoea by about a day, and help when diarrhoea follows antibiotics. Evidence differs between products. Examples available at Khasmart include Reuflora Sachet, Protege Sachets, Enterogermina and Amybact, which contains Saccharomyces boulardii. They are an extra, and they never replace ORS. Ask your doctor for people with weak immunity or serious illness.

Anti-diarrhoeal medicines

• Racecadotril (Hilrace) reduces the amount of fluid secreted by the gut, and is used in some children and adults alongside ORS, as advised by a doctor.
• Loperamide slows the gut. It must not be used in children (generally under 12), or if there is blood in the stool, high fever or severe belly pain. In those cases it can worsen the illness. It is sometimes used for short periods in adults with mild watery diarrhoea.
• Antibiotics are not needed for most diarrhoea, since most is viral. They are used for cholera, dysentery with blood and fever, and some other infections, only on a doctor’s advice. Read our guide to antibiotics.
• Do not give opium-based home mixtures, or old tablets, to children.

See the diarrhoea category. Prescription items require a valid prescription, and you can upload it here.

Signs of dehydration

• Dry mouth and tongue, thirst, or no tears when crying.
• Passing little urine, or none for six to eight hours, and dark urine.
• Sunken eyes, and in babies a sunken soft spot.
• Lethargy, drowsiness or irritability, cold hands and feet, fast breathing.

When to see a doctor or go to hospital

• Signs of dehydration, or a child who is unable to drink or keeps vomiting.
• Blood or mucus in the stool, or black stool.
• High fever, or severe, constant belly pain.
• Diarrhoea lasting more than two to three days in a child, or more than a week in an adult.
• A baby under six months, an elderly person, a pregnant woman, or someone with diabetes, kidney disease or a weak immune system.
• Watery, rice-water stools in large amounts, which may be cholera.
• Recent travel or contact with floodwater. See our guides to waterborne diseases and typhoid fever.

Prevention

• Wash hands with soap after the toilet, after changing diapers and before eating or cooking.
• Drink boiled or filtered water, and wash fruit and vegetables.
• Cook food thoroughly, cover it, and refrigerate leftovers quickly.
• Clean baby bottles carefully. See our feeding bottle guide.
• Breastfeed for the first six months if possible.
• Make sure that your child has the rotavirus vaccine, and routine vaccines on schedule.
• Keep a few ORS sachets in your home first aid kit.

Frequently asked questions

Should I stop food and give only water?

No. Keep feeding, and use ORS for fluids. Starvation prolongs diarrhoea.

Can I give sugary drinks or cola for diarrhoea?

No. They can worsen diarrhoea because of their high sugar. Use ORS.

Is it safe to give milk during diarrhoea?

Breast milk and formula should continue. In some children, milk may temporarily upset the stomach, but do not stop without medical advice.

How long does gastroenteritis last?

Viral diarrhoea usually settles in three to seven days.

Order ORS, probiotics and prescribed medicines from Khasmart, with delivery across Pakistan.

This article is for general information and is not a substitute for advice from your doctor or paediatrician. It does not include doses; your doctor decides the medicine and amount, especially for children. Always follow the directions on the pack or from your doctor.