This article is part of a video series with Dr. Changa Kurukularatne, a specialist in infectious diseases and internal medicine; he is a father of four. Dr. Changa has worked in multiple countries from the U.S. to New Zealand and Singapore.
Dr. Changa: This is a very, very common public health issue that I've certainly been involved in. Diarrhea, this is plaguing our children in this planet at an unprecedented rate, and when coupled with malnutrition can be really, really fatal. So, regulatory authorities and the health authorities like the WHO have very active campaigns to tackle dehydration. And oral rehydration fluids are used successfully to minimize the effects of diarrhea, for instance. And so these are fluids that have a mix of salts and sugars.
What I tell parents is just remember this one interesting detail, the channels that absorb water in our intestines, the fancy name is sodium glucose sin transporter. And what that means is, so you need sodium, salt, and glucose is a kind of sugar, they have to work together to transport water across the intestine membrane to your body. So if you just drink water without any electrolytes, or the little elements that are in the water, yes, it's better than nothing but you may be creating a situation where you just get bloated. And basically, you're diluting your body in a way. But if you alternate water with something safe but salty, like a broth, you can make a vegetable broth at home, and then the next time around, you have something safe but sweet, like a freshly-made fruit juice.
So imagine this, so your child has a diarrhea, there's no vomiting, so you're able to give your child liquids to take, the first I will say, 9:00 a.m. can be a little bit of water, not too much. 10:00 a.m. could be a little bit of a soup or a broth. 11:00 a.m. could be some papaya juice and 12:00 noon could be some coconut water. What you've just done, even if it's 100 ml or half a glass at a time, now you've created the ideal situation for your body to absorb not only the world but also the electrolytes your body needs to feel healthy. Coconut water is something that I like very, very much because it is the equivalent of nature's Gatorade, if you will. It has a lot of potassium, which we lose when we have diarrhea. It has some of the fruit sugars that will give us some energy, and it'll create a situation where water is better absorbed. So, coconut water is a great go-to when you want to replace lost fluids.
Dr. Linnea: What is an alternative in, let's say, North America that people can easily get access to?
Dr. Changa: In North America, you could go to the store and get coconut water. But I do understand that while here we may have the fresh coconuts, worldwide, you still can access coconut water in a carton. If you go with a reliable brand, you could get a very decent product without a lot of the chemical burden that comes with it. If this is not an option, then I would just say reach for a blender and make some fresh fruit juice from fresh fruit. You can just blend it with added water, that can be set aside and then you can make a quick vegetable soup. So that's your salty and your sweet and then you could alternate between those two interspersed with water.
And then, that is the safest and the fastest way to get your child to feel better. It's a bit more challenging with vomit because when you have nausea and vomiting, it's really difficult to hold down food or liquids for that matter. And the key there is to use small, frequent amounts of liquid intake. If a child with nausea gets a full glass of water in his or her tummy, it will just come out. So, be patient, and sips a time, small amounts so that the tummy will not feel too stressed and will actually keep it in, that's the way to go.
There is a misconception out there, even among providers, that intravenous is better than the oral route. And that couldn't be further from the truth. Whenever possible the oral route is the best to replace fluids. When we're dealing with the situation that the oral route is not available anymore, not an option anymore, then and only then should we use the intravenous route.
There are a lot of trends where people would say, “Oh, just give me an IV and I'll be fine.” And there's a certain amount of a placebo effect associated with that. Of course, the intravenous can be given faster, I suppose, but faster doesn't always mean better. Anytime you take a needle and you puncture a vein, there's a risk of phlebitis, there's a risk of infection, there's obviously the pain that's associated with it. And child or adult, if you can consume liquids through the oral route, that is a very, very appropriate way to replace lost fluids.