Melanie M woke up one morning
last week with a tummy ache, fever and chills. She figured
it was a 24-hour flu, popped an acetaminophen and went
back to bed. What she didn't realize was that the rumblings
in her stomach weren't due to the flu bug but rather
a bacterial infection from last night's dinner.
Twelve hours later, Melanie
set up camp in the bathroom, alternating between horrible
bouts of nausea and the runs. After another agonizing
48 hours, she packed up and headed straight for the
nearest hospital. Her fever hovered close to 39�C and
she couldn't even keep water down. She was extremely
dehydrated and on the verge of collapsing.
Millions of Canadians get hit with
a bout of food poisoning every year. Be it last night's
takeout or homemade tuna salad sandwich, all foods are
potential suspects when it comes to food poisoning.
Bacteria that cause gut wrenching bellyaches can hit
when least expected, and many of your patients may wind
up in your waiting room looking for relief. Here are
some tips on how they can deal with food poisoning
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FOR THE ANTIDOTE
• Drink up The catch with food poisoning
is that it takes a positive stool sample to confirm
the diagnosis so in many cases you'll be sending your
patients home with a list of things to do until the
results come back. Dr Arni Sekar, an Ottawa gastroenterologist,
says that patients need to stay hydrated. "You should
tell your patients to drink lots of fluids," he says,
"things like Gatorade are good." He also adds that patients
should avoid coffee because it dehydrates and isn't
good for diarrhea. They should also stay away from dairy
products.
• Mild cases Symptoms
for food poisoning can run the gamut from five to 10
bowel movements a day to upwards of 30. Regardless of
this, treatment for mild cases of food poisoning is
pretty routine. Dr Sekar claims that bismuth subsalicylate
will ease some of the symptoms. "For a mild illness
I also don't mind using loperamide," he adds.
• When they've got it bad
A patient who comes in with fever, severe diarrhea,
abdominal tenderness and generally looks like he/she
should be in emergency qualifies as a severe case. Dr
Sekar says that this usually means that some sort of
viral or bacterial infection still persists. With these
more severe cases loperamide should be one of the first
things you should tell your patients to avoid,
explains Dr Sekar. "Loperamide will slow down the transit
time and that means the bacteria isn't getting out,"
he says.
• Give it a rest
Dr Sekar believes that one of the best ways to deal
with food poisoning is through diet. "Resting the bowel
will do the trick," he says. Antispasmodics are sometimes
prescribed but he cautions that they rarely make any
difference. Prescribing antibiotics can also be a point
of contention. "Although food poisoning is caused by
bacteria most of the time people don't need antibiotics,"
says Dr Sekar, "the only case where a patient needs
antibiotics is if they're systemically ill."
• Once the coast
is clear Mild cases of food poisoning usually clear
up after three to four days while more severe cases
can take a little over a week to run their course. "You
can tell your patients that it may take a while for
them to tolerate lactose," says Dr Sekar, "and I would
tell them to avoid fibre for a week or two to get used
to eating again." He also advises that if your patients
experience flare-ups that they come back immediately
to see you.
• Post-infection
Dr Sekar points out that for some patients symptoms
might last longer than normal. "I see patients like
that often," he says, "a patient has some sort of food
poisoning and then for some reason the bowel movements
haven't been the same." He says this is quite common
and such symptoms usually mean that the patient is suffering
from post-infectious irritable bowel syndrome. If your
patients are experiencing these kinds of symptoms, they
should be advised to see a specialist to rule out more
serious health problems.
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