Every day 1 out of 9 child deaths occur due to diarrhea. In fact every year diarrhea kills about 760,000 children under the age of five, and it is the cause of 10.6 million deaths across the globe. Diarrhea is the second most common cause of death among infants. Although children are more prone to death from diarrhea, it can be equally life-threatening among adults if it not properly managed. Many people are not aware that infections which cause severe diarrhea lead to death not because of the infectious agent (like a bacteria or parasite) but from the diarrhea itself.
Diseases That Cause Deadly Diarrhea
Just about any diarrheal disease could lead to death if it is severe and not properly managed. However, some are more likely to lead to death than others largely due to the age group that is more prone, as well as the delay in proper treatment and management. Acute diarrhea that is due to certain infections are often severe and more likely to result in death. Some of the causes include:
- Viral – Rotavirus (most common for children), norovirus (most common for adults), adenovirus, astrovirus and calcivirus.
- Bacterial – Escherichia coli (E.coli), Campylobacter, Shigella, Salmonella, Vibrio cholerae, Clostridium difficile and perfringens.
- Parasites – Giardia species, Entamoeba histolytica.
Despite the fact that infectious diarrhea is very common and most likely to be severe, there are other causes of diarrhea that could also lead to life-threatening complications. Chronic causes may also lead to acute flare-ups of severe diarrhea that need to be properly managed in order to prevent potentially fatal complications. However, the reason why diarrhea leads to death in some people and not others is due to a multitude of factors, and not only dependent on the severity and management.
Sometimes other underlying factors can contribute to diarrhea become deadly, particularly in young children and the elderly. Malnutrition is one of the leading factors in this regard. An adult or child who is malnourished has a greater chance of contracting diarrheal infections, the severity may also be worse and recovery takes longer.
People with a weakened immune system, like those with HIV/AIDS, are also at risk of infectious diarrhea becoming deadly. These immune-compromised individuals are also at risk of contracting rare organisms that can cause diarrhea and which are not easy to treat. A history of kidney and heart disease may further complicate the prognosis of diarrhea, particularly in the elderly.
How Does Diarrhea Cause Death?
The cause of the diarrhea itself is not usually deadly. Instead it is the complications that arise as a consequence of diarrhea. It is important to remember that diarrhea is just a symptom and not a disease on its own. By far the most common cause of death from diarrheal illnesses is a result of severe dehydration. This is a where the quantity of water and electrolytes in the body are lower than normal. It eventually causes disturbances in almost every organ and tissue in the body, and particularly in the kidney, heart and brain.
Dehydration in diarrhea illnesses is largely due to fluids lost in the stool, through vomitus if vomiting is present and to some extent through excessive perspiration as well. Normally water and electrolytes are absorbed from the food and beverages consumed. Initially water is pumped out from the body into the digestive tract to aid with digestion, but in the large intestine most of this water is resorbed. In this way the body preserves water. Excess water and electrolytes are normally excreted though the kidneys in the urine.
Water and electrolytes are needed by every cell in the body. When the levels are too low, it can lead to the following:
- Abnormal heart rhythm (arrhythmia)
- Inability for the kidneys to excrete wastes (kidney failure)
- Swelling of the brain (cerebral edema)
- Abnormal electrical impulses with involuntary muscle contractions (seizures)
- Low blood volume (hypovolemia) leading to low blood pressure (hypotension) and low oxygen levels (hypoxia)
Eventually this will progress to a coma and death can occur.
Duration and Quantity of Diarrhea
How long do you have to have diarrhea for it to be deadly?
The duration of the diarrhea is not as much as a concern as the quantity of water and electrolytes lost in the diarrhea. Sometimes just a day or two of profuse diarrhea can lead to significant fluid and electrolyte loss. At other times, small amounts of fluid and electrolyte loss over days or even weeks can lead to severe dehydration. Diarrhea can last for as short a duration as 1 or 2 days (norovirus) to 2 weeks (adenovirus and Entamoeba histolytica) Some infections can cause diarrhea for several weeks (Yersinia enterocolitica) and even months (Cryptosporidium species).
How much fluid and electrolyte loss for diarrhea to be deadly?
It depends on the amount of fluid lost in the stool versus the fluid and electrolytes consumed or administered in an attempt to rehydrate. In severe cholera diarrhea, a person can expel 10 to 20 liters of diarrhea stool in a day. It not only depends on fluid but also on electrolyte loss. Dehydration can be classified as mild, moderate or severe by the fluid loss based on the percentage of body weight.
- Mild: 5% (infants) or 3% (adolescents)
- Moderate: 10% (infants) or 5-6% (adolescents)
- Severe: 15% (infants) or 7-9% (adolescents)
While these percentages are a helpful guideline, it is better to identify the degree of dehydration by the symptoms that are present.
Recovery from Diarrhea and Dehydration
It is possible to recover from even severe dehydration if effective measures are implemented quickly and appropriately. Rehydration is the main course of action, but it is equally important to stop the diarrhea. While antidiarrheal medication may be useful in stopping the diarrhea, it is not always advisable in every case. Instead the diarrhea should be treated at the root cause while rehydration continues.
Rehydration is the replacement of fluid and electrolytes that are lost with diarrhea. It is done over several hours to days. Rapid rehydration can cause complications therefore it has to be carefully coordinated. Oral rehydration is the preferred route in the home environment and to prevent moderate to severe dehydration. However, if oral rehydration is not possible (due to vomiting or unconsciousness) then intravenous (IV) fluid administration is necessary.
Many people opt to use fruit juice and soda for rehydration. This is not advisable and can even worsen the diarrhea. Instead commercial oral rehydrating solutions (ORS) should be used. It has the optimal concentration of electrolytes for absorption into the body rather than drawing out fluid from the body into the gut. A home-made ORS will also suffice. Rehydration should be continued for several days even after the diarrhea stops.