Diarrhoea and ORS: When the solution is the problem.

Chichi walked into the doctor’s office that afternoon carrying her seven-month-old son in her arms. “Good afternoon doctor,” she greeted. “How are you today?”

“I’m fine, thank you,” Dr Momodu responded, as he motioned for her to sit down. As she sat, he observed her closely. She had her lower lip pressed firmly against the upper one, with worry lines creating race tracks across her face. “What seems to be the problem ma’am?” he asked gently.

“Doctor,” she began with a sigh, “my baby has been having diarrhoea for some days now and a friend said it’s because he’s teething. I’ve used paracetamol, teething powder, and Oral Rehydration Salt solution but instead of getting better, he’s getting worse. He’s so weak now that I’m scared. I was going to buy antibiotics for him but I’m not even sure which one is the best for this,” she said with a tone of deep concern. “He’s my only child and it took me several years to have this baby. I can’t let anything happen to him,” she said, her eyes glistening from unshed tears.

 Ah! That is it, Dr Momodu thought. That’s why she’s seemed extra worried. He understood the feeling all too well having had a delay in childbearing himself. “I’m sorry about that ma’am. Let’s get to the root of the problem, so we can begin treating him as soon as possible, shall we?” Dr Momodu asked.

“Yes,” Chichi responded faintly.

“So from the very beginning, how did it start?”

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Three days ago…

Chichi moved around the kitchen as fast as her legs could go trying to finish up a dozen tasks ahead of her. She felt like she was moving to the rhythm of a ticking time bomb, albeit a mental one. Tike, her son, would soon tire of playing with the toys she had used to distract him, and when that happened, he would begin to scream. That was the cause of her agitation.

Barely two minutes later, Tike gave a loud scream and began crying.

“Oh, c’mon! Not even five minutes?” Chichi said with a frustrated sigh. She tried pacifying him by singing a few songs but he was having none of it. He yelled even louder so, she scrambled to his side.

“Tike my boy, what is it, ehn? You’ve been very cranky and clingy today,” she chided playfully as she lifted him. A foul smell from his diaper made her nose curl. “Oh, you’ve pooped? No wonder! Let’s go get you a fresh diaper,” she said as she proceeded up the stairs to his room.

Tike’s stool was unusually watery and greenish in colour. ‘Hmmmm, that’s quite odd,’ Chichi thought but she didn’t let it bother her.  However, when Tike had two more episodes of very loose stool during the next hour, she knew something was wrong. She put a call through to Adanna, his godmother.

“Hey Adanna, how are you?” Chichi greeted.

“I’m fine baby girl. How is my love?”

“Shoo, am I not your love again?”

“Who are you?” Adanna teased. “Tike is the only one I know.”

“No wahala… since that is what it has come to. Anyways, he is okay but he has just been passing loose watery stool.”

“Oh! Na teeth,” she responded. Babies tend to have diarrhoea when their teeth are about to come out.”

“Okay. So what should I do?” Chichi asked.

“There’s one herbal paste we used back in the day but I don’t know where you can get it now. In the meantime, you can rub garlic on his gums, and then give him paracetamol, teething powder, and ORS,” Adanna said. “It’ll make him feel better.”

“Why does that sound like a herbalist’s concoction?”

“Thunder fire you there! Na you be herbalist.”

“No be only thunder, lightning nko? Aunty calm down joor… Somebody cannot even play with you again!” Chichi said laughing.

“See your big head,” Adanna teased back.

“Anyways, I’m not rubbing garlic or any paste on my son’s gums; the others, I can try,” Chichi replied.

“Okay o. Just take care of my love for me, you hear?”

“I hear.”

“Oya now, bye bye,” Adanna said.

“Bye,” Chichi replied as she hung up the phone.

Chichi went to a renowned pharmacy and purchased the medicines which she began using for Tike immediately. She was very careful to ensure that he got enough fluids including the ORS, and hoped he would recover soon. However, that was not the case. Tike worsened, getting weaker and weaker despite all she did. By the next day, Chichi was certain that her mind was playing tricks on her because Tike felt significantly lighter like he had lost some weight. Which kain thing be dis? Or should I get him antibiotics? No! I better take this boy to the hospital because I won’t forgive myself if anything happens to him.

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“So that’s how I came here doctor,” Chichi said.

“Well, first of all, teething doesn’t cause diarrhoea but that is another discussion. It seems to me that your son may have lost a lot of body water from the diarrhoea he’s having which explains why he lost weight.” Dr Momodu replied.

“But doctor, I was giving him fluids, especially ORS,” Chichi interjected.

“Did he take it well?” Dr Momodu asked, stroking his grey-tinged beard.

“Yes. In fact, he would finish the first cup and sometimes take another,” Chichi responded.

Dr Momodu asked a couple more questions and then said, “Well, let me examine him.”

Baby Tike looked very weak.

His eyes were sunken, his breathing was rapid, and his heart was racing like he was being chased by a wild animal. His skin was a bit loose and he had definitely lost some weight. Dr Momodu made an assessment of moderate dehydration due to diarrhoea disease. He was about to sit down when a thought came to his mind. “Could you show me the quantity of ORS he would usually take after an episode of loose stool?” he asked Tike’s mum.

Chichi unzipped her bag and brought out a bottle of ORS from her bag. She poured it into Tike’s cup and showed it to Dr Momodu.

“Is this the exact solution you’ve been giving him?” Dr Momodu asked.

“Yes. Why?”

“Now it makes sense why Tike is so dehydrated, despite taking ORS. That solution is the problem!”

“How do you mean? Is the ORS fake?” she asked with an undertone of panic.”

“There’s something wrong with the mixture,” he answered.

“But I got it from a very reliable pharmacy, and I checked the expiry date and NAFDAC number before giving it to him, and both were okay…” Oh God please let nothing bad happen to my baby. I’ll sue that pharmacy if anything happens, Chichi thought.

“Oh no, that’s not it. I don’t think the ORS is fake; it just wasn’t well prepared… It wasn’t mixed right.” Dr Momodu responded.

“I beg your pardon! That sounds like an accusation to me. I prepared the ORS myself!” Chichi exclaimed.

“Okay, I’m sorry. But how did you prepare it?” he asked.

“First, I washed my hands thoroughly with soap and water, and then I got a new bottle of water, and poured the contents of the sachet inside. After that, I shook it well to ensure that it was well dissolved before I gave him,” she said demonstrating with the bottle she brought along. “What is wrong with that?”

“The bottle, ma’am,” Dr. Momodu replied. “That is a 75cl bottle, that is 750mls; and the instructions for preparing the oral rehydration solution are clearly stated: 1 sachet is to be dissolved in one litre of water.”

“Well, but… But isn’t 75cl approximately 1 litre?” Chichi stuttered.

“75cl is approximately a litre the same way 750k is approximately a million naira,” Dr Momodu said with a chuckle. “There’s a world of difference between both… or have you ever heard of an approximate millionaire?”

“Ummm, nope,” she responded.

“Me neither. Here’s another analogy: If your monthly salary is 100k, and your boss pays you 75k, would you say its approximately the same?”

“Ah! No,” Chichi replied as she quickly did the math. “That’s a 25% cut!”

“But that’s exactly what you did to your son. Using 75cl to prepare the ORS is making a 25% cut on the water he needs.”

“Ouch!” Chichi remarked.

“Now imagine that when your boss made a pay cut is a month when you had an emergency that takes off 60k every month. How would you manage?” Dr Momodu asked.

“Wow…It’s going to be tough.”

“And even if you borrow from others but if the pay cut and the emergency continue for several months, how long do you think you’ll be able to survive on the remaining 15k?”

“Not long actually,” she replied.

“Exactly! Diarrhoea is like the emergency in this analogy because it’s causing unexpected loss of body fluid. Giving a highly concentrated fluid is like the pay cut because you’re not giving enough water. Do you now understand why giving highly concentrated fluid to someone who has diarrhoea would rapidly increase the deficit and make the person worse?

“Yes. I do,” Chichi replied, nodding vigorously.

“And if nothing is done about it, the person could begin to have more symptoms like vomiting, convulsions, loss of consciousness, and even death.”

“God forbid!” Chichi said, clutching her son tightly to her chest.

“Yes, God forbid. And you too must forbid. Follow the instructions indicated on medicines, no matter how small or how common the medicines are.”

“I forbid o. Doctor, I forbid,” Chichi cried out. “Please let’s proceed with the treatment. I hope my baby will recover well?”

“Thankfully, the dehydration is not yet severe so we can hope for the best.”

“Okay, thank God. Thank you, doctor.”

“You’re welcome,” Dr Momodu said with a smile.

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Five quick tips for using ORS (Oral Rehydration Salts)

• An ORS sachet contains a combination of salts and sugars that are not uniformly blended so it is wrong to pour half a sachet into a 50cl bottle of water. If you don’t have a big enough bottle, mix the solution in a large covered bowl instead of trying to manipulate the sachet’s contents.

• Do not dissolve a sachet of ORS in milk or juice. Do not add extra salt or sugar to the contents of the sachet because it would increase the concentration of the solution. Use only clean drinking water.

• Any solution of ORS that is not finished in 12 hours (when stored at room temperature), or 24 hours (when stored in the fridge) should be discarded because there is a risk of bacterial contamination.

• If you don’t have access to ORS, you can make a simple salt-sugar solution by dissolving eight level-teaspoons of sugar and one level-teaspoon of salt in one litre of water.

• If a child is vomiting severely or is unable to take a solution of ORS, he/she should be taken to the hospital as soon as possible.