Diarrhea: Deadly and Not

I guess I can tell you all. I am doing the prep for a colonoscopy tomorrow, tonight. I basically take this saline solution. And thru reverse osmosis, it goes right thru me.

This got me to thinking. Why is some diarrhea deadly and some not?

I am talking specifically about cholera. Cholera comes from drinking contaminated water. We don’t drink contaminated water in the United States. So we rarely get it here. But it’s still a real concern in some third world countries. And it is often deadly.

It apparently gives you severe loose stool. And then you die of dehydration, whether you drink fluids or not.

As I said, the saline solution goes right thru me. But it uses reverse osmosis. So that might be the reason why it doesn’t kill me.

Anyway, I don’t mean to get graphic. But I am prone to diarrhea. And it can be quite severe, very watery and whatnot. But I never die.

I’ve never seen someone with cholera. But I assume that there is nothing out of the ordinary about their diarrhea. Yet it often kills them. Why does kill them?

Why is some diarrhea deadly and some not, even when they are outwardly the same (or so I assume)?


The sheer volume of fluid loss is what kills them. Some places even have “cholera beds”, which have a hole in the middle and they put a bucket underneath it. It’s marginally more sanitary than having them lie in their own waste, and some places used them for Ebola patients during that outbreak in 2014-15.

If they receive IV hydration, or oral hydration if they can keep it down, for 24-48 hours during the acute phase, they usually recover. If not, they almost always die, especially if they are children or elderly.

Colonoscopy prep is designed to do no more than empty the matter already in your bowels. That’s done through the use of laxatives. They speed up the normal evacuation of water, food, and bacteria. There are several combinations of laxatives used, but they normally do not use reverse osmosis. Do you have the exact names and ingredients of the prep pills and liquids so we can check?

Anyway, the clearing out is aided by your refraining from anything other than clear liquids for 24 hours. Eating food afterward starts resetting your system back to normal. It is not a continuing ongoing process. Cholera-type diseases continually drain the body of water and lead to dehydration. A colonoscopy prep does not do this because you continually add clear liquids throughout the prep. They prevent dehydration and any excess can be excreted normally through the bladder. Therefore two entirely different processes are involved.

Yeah, colonoscopy prep won’t kill you for the reasons already explained above. It may cause you to wish otherwise (the taste alone is close enough to being lethal). If cholera patients in the past (or in parts of the world lacking both sanitation and medical technology) could have (had) access to an IV fluid drip, they’d probably all survive, although electrolyte imbalance could still take them out if it lasted long enough. (You need potassium and sodium and calcium supplements because you lose that along with the water).

Gavilyte-N Solution.

Doesn’t the IV drip contain electrolytes? I’m fairly sure it contains sodium if not the others.

Depends on the IV. D5W is just glucose and water. 0.45 Normal saline is a hypotonic concentration of sodium and chloride, about half the concentration of normal blood serum. There are a variety of concentrations and formulations etc. that can be put into an IV bottle.

Many people expiring of cholera could also have been saved had they had access to an oral electrolyte rich rehydration solution, basically water with added NaCl and bicarb. A whole lot easier to obtain and administer than IV fluids.

Just some personal anecdotes…

I’ve had two colonoscopies and had no problems with dehydration (just a funny feeling when they actually put the tube up!)

After a recent (vigorous :roll_eyes: ) encounter with diarrhea, I made sure I drank plenty of water and then had a meal of salad and jacket potato. Today I’m fine. :grinning:

What kills you in cholera is not just the dehydration but also the loss of essential electrolytes. Rehydration must be accompanied by the restauration of those electrolytes. There is a special solution of sugar and minerals that is used and will generally prevent death until the body recovers from the disease.

AFAIK, that’s a standard laxative and does not work through reverse osmosis.

Curious: does a cholera patient typically vomit? That’d certainly make the oral rehydration solution less effective.

But as QtM notes, the cheap, easy-to-assemble oral rehydration solution is literally a lifesaver. Diarrhea can kill regardless of the cause - and people in areas where the water / food supply tends to be contaminated can and do die of it, even when the cause is something other than cholera.

It might be tough to get someone (especially kids) to choke down the solution - I know when my son had some stomach issue we tried to get him to drink Pedialyte; he took one sip, announced “YUCK”, and wouldn’t touch it any more.

So yeah, colonoscopy prep is like a miniature - and time-limited - preview of what it’s like to have cholera (I guess) or norovirus (I know!). And even with the prep, they are concerned with the electrolytes, which is part of why some of those products taste so vile - they contain not just the “earth-shattering kaboom” stuff, but electrolytes. I’ve always used alternatives, and the doc has always said “take them with Gatorade”.

For most people, once that stuff has run through your system, you’re done with the trots (for some lucky folks, it lasts a bit longer) while with a pathogen, the viruses or bacteria are likely still trying to make more little pathogens for quite some time.

I would imagine that even without supplemental electrolytes, most people would be just fine with something that lasted only 24 hours, but some vulnerable patients would NOT do as well. It’s why parents are told to keep a close eye on their young kids, for signs of dehydration.

Osmosis is definitely a thing in colonoscopy prep. Is reverse osmosis even possible in mammals? I thought that required a fair bit of added energy to force ions to do what they don’t normally do.

The primary mode of action is thought to be through the osmotic effect of polyethylene glycol 3350 which causes water to be retained in the colon and produces a watery stool.

The osmotic effect of unabsorbed sulfate anions and the associated cations causes water to be retained within the gastrointestinal tract. The osmotic effect of the unabsorbed ions, when ingested with a large volume of water, produces a copious watery diarrhea.

Underlining mine.

I suppose one could get their electrolytes at home during a pandemic when all the restaurants are closed. But where’s the fun in that? :wink:

I’d imagine cholera patients would need a hefty dose of probiotics as well to replace all the natural flora that’s getting flushed out of their intestines.

That being said…it’s hard to imagine death from diarrhea unless cholera is nonstop, nonstop diarrhea - especially since Wikipedia said death from cholera can sometimes happen in as little as two hours - is it basically like a nonstop faucet in your ass causing fluids to be lost until you’ve already been fatally dehydrated before you even know it?

I have yet to meet a prep that didn’t have me crapping for multiple days, the average tends to be the original day plus 3 to 4 additional. Yay.

I was hospitalized during the radiation plus oral chemo portion of treatment because of extreme diarrhea - to the tune of 2 bags [1 regular, 1 banana] full bore for the first 2 days, 12 liters. It was going out pretty much as fast as it was going in because I had no gut lining left to keep the interstitial fluid in my body, it was pouring out my butt. [sorry] Immodium [8 times the normal OTC dose] plus lomotil [hyperpoo med as we jokingly referred to it, it has atropine in it] does not work on diarrhea like that because it isn’t a matter of slowing the peristalsis long enough to work, there is no gut lining to slurp the liquid out of the poo stream. It took time out of treatment to get enough gut lining restored before finishing the last week of treatment. If I had access to the old school kaopectate - kaolin and pectin - to soak up the excess volume of liquid, it might have worked long enough to get me through the treatment. [and FWIW, I was drinking 4 to 6 liters a day of electrolyte replacement beverage given to me by my radiation oncology team] I was literally within days of organ failure from dehydration. Yes, I can see death by diarrhea. [I had a verified 17 minutes mouth to toilet bowl doctor verified - tracked by undigested watermelon just eaten. Yay.]

Aru, sounds beyond awful on just about every level I can think of!!!

I’m one of the ones whose colonoscopy prep is the gift that keeps on giving - though in my case it’s a few hours, not days. I do have an issue these days with chronic diarrhea - probably some combination of bile acid diarrhea / irritable bowel thing - currently being treated with some effect. I wonder about longer-term health issues such as nutrient deficiencies associated with food becoming short-term rental.

Diarrhea has always been one of the leading causes of death throughout the entire history of humanity. It’s been a major cause of infant mortality too. The GI tract is susceptible to a lot of different toxins and infections that can cause it to go from an absorptive surface to a secretory one all too swiftly. When it uncontrollably puts out not just water, but also electrolytes, death is not far away. And when that absorptive surface sloughs off due to radiation or other causes, blood and vital proteins exit just as quick.

Some cholera patients vomit, but it’s not a universal symptom, so that’s why oral rehydration solution is feasible.

(And you need to use clean water, of course.)

Back in my military days, I traveled to places no sane person would have on their dream sheet, and sometimes on short notice (think hours, not days). We had to stay up to date on all shots (except GG), including cholera, which was only good for 6 months, so I’ve had a few of those.

Later, as a civilian, I had another chance to travel to a less developed part of the world. I was not given a cholera shot. I was told (so no cite) that the current thinking was if I came down with cholera, the plan was plenty of IVs and evacuation to a better equiped location, where I would be taken care of in fine style.

I dunno if that is still true, or if I was fed a line of BS, of if cholera wasn’t as serious a threat in that part of the world. I’m just sayin’.

Well, I just feel compelled to point out (on the colonoscopy prep this time), that as bad as it is, it’s worth it in the end.

Colonoscopies are not just diagnostic, they are preventive too, because they remove pre-cancerous polyps. So if your doctor says you need one, get it!