Hypothetical question, but whenever I have eaten something that irritated my stomach and digestive system, or when I have had food poisoning or a viral infection I was always told to not stop myself from vomiting or having diarrhea since that is how your body is trying to get rid of the infection or irritant. Normally when I eat something that doesn’t sit well it only takes 1-2 bouts of vomiting and diarrhea before I feel (more or less) fine again. Food poisoning takes a day or so, but I avoid using medicines to stop myself from expelling what I ate.
But at what point does the risk of dehydration, electrolyte imbalance and damage to the digestive system (from constant diarrhea and stomach acid from vomiting) become more important than letting your body vomit and have diarrhea to get rid of an irritating food or pathogen? If a person is vomiting and having diarrhea every 10-15 minutes as an example, that works out to about 25-30 bouts every 6 hours, which seems like it could be gallons of fluid. Can a person keep expelling their digestive contents that rapidly, just so long as they are getting enough liquid and enough salt and potassium? ie, if a person is vomiting and having diarrhea every 10 minutes or so is that considered relatively ‘safe’ just so long as they are replacing the fluids and electrolytes lost by doing that?
I’ve heard cholera can kill within a few hours w/o treatment due to diarrhea and fluid loss. Granted, I think cholera used diarrhea as a way to spread itself (so it is in the pathogens interest for you to have diarrhea, not your own). But evenso, it seems stopping the diarrhea is more important than expelling the pathogen at that point.
Basically, is there a cutoff point where if someone has food poisoning, it is better to stop the vomiting and diarrhea (even if it keeps the pathogen in their system longer) instead of run the risk of complications from dehydration, electrolyte imbalance and too much trauma to the digestive system? Or can a person more or less vomit and have diarrhea all day, just so long as they are getting enough water and minerals to replace what is lost?
Or does a serious bout of vomiting and diarrhea cause no more water loss and electrolyte imbalance than exercising on a hot day? I believe you need 1-2 liters an hour of water if you are exercising in heat. Can a person maintain that level of activity for hours just so long as they are replenishing their electrolytes and water, or does passing (and then reabsorbing from diet) grams of sodium and potassium and liters of water an hour cause health risks in and of itself?
Vomiting just empties out the stomach; as such it’s not a big source of fluid loss. It just prevents oral fluid from getting in. If a person’s vomiting intractably, use of antiemetics like zofran can help minimize that.
Diarrhea is more problematic; one can lose critical amounts of fluid that way very quickly.
My rule of thumb: If they are having orthostatic blood pressure changes due to fluid loss from diarrhea and aren’t able to keep oral replacement fluids down, it’s time for IV hydration.
It’s always helpful to try to identify the cause of the diarrhea. If it’s a virus, continued supportive care is about all you can do. Same for most bacterial food poisonings. But if it’s due to C. Difficile infection, then antibiotics may be necessary to knock that bug out, and fecal transplant could be considered to normalize gut flora again. If the bowel is disabled by drugs or metabolic problems, correcting that will be key to stopping the diarrhea.
Slowing the diarrhea down is considered in some cases, using imodium or similar medications. But it’s more of a comfort measure than one of trying to prevent further dehydration. At least as long as you have replacement fluids successfully going in.
But assume someone is losing a couple of gallons of fluid every 6-8 hours due to severe diarrhea. As long as you are drinking 2 gallons of fluid every 6-8 hours and taking them in as fluids high in sodium and potassium (orange juice, chicken soup, pedialyte, gatorade, etc) will such a rapid increase and decrease in fluid and electrolyte levels damage a persons health? Can the human body withstand taking in and losing several gallons a day of water and several grams of electrolytes, just so long as you are taking in as much as you are losing? Or do things like severe diarrhea or working outdoors in 110F+ weather cause such rapid and profound changes in hydration and electrolyte levels that even if you are replacing those things at the rate you are losing them (drinking a gallon of liquid every 2-3 hours, taking in several grams of potassium and sodium every 6 hours, etc) you are still putting your health at risk?
I remember when he explained this before and yes, yes it does. (Of course it screws with one my favorite phrases which is “The only way he could be more full of shit would require the use of a pump, a hose, and a bag of manure.”:D)
Lots of variables here. If the loss is due to accelerated normal processes, like sweating during hot weather, the body can probably absorb replacement fluids and electrolytes. If the loss is due to a secretory diarrhea, where the body is actually pumping out fluids and electrolytes into the GI tract against normal gradients, then there’s no way that oral replacement can keep up. And if the person is vomiting or having lead-pipe syndrome, where what’s poured in the top runs out the bottom, then the chance of health or life-threatening electrolyte imbalances goes way up.
But other factors come into play also, such as core body temperature, how efficiently the body is cooling itself, how well the kidneys are being perfused, etc. etc. So people can get into trouble with malignant hyperthermia despite attempts at adequate hydration.
In short, and as a rough rule of thumb, I’d say that if the person is losing fluid through normal body processes under relatively ordinary conditions, & they can replace fluids and electrolytes at will, they’ll probably be okay. But throw in losses due to a disease process or exceptional conditions (working in 99% humidity at 100 degrees Fahrenheit) and the body may not be able to compensate.
Just to throw in the pediatric perspective. We usually have a big advantage over internists in that we typically have one or more parents around to help out, as a result we much more often can succeed with an oral rehydration therapy (ORT)protocol. I say “can” rather than “do” because, as those articles points out, despite the fact that it is safe and effective it is a very significantly underutilized approach.
That said, since the wide availability of a vaccine against the germ Rotavirus, the virus that traditionally caused the most of the most severe vomiting and diarrhea illness with dehydration in childhood, the number of children needing serious rehydration protocols of any sort has substantially decreased. (Admissions down roughly 90% within two years of its introduction even with only partial vaccine coverage.)
How dare you laud the efforts of those greedy drug companies and vaccine manufacturers? Don’t you know they’re only in it to make money, side effects be damned? Anyway, it’s better to fight off the virus naturally.
(Disclaimer: Yes, this is sarcasm)