GASTROINTESTINAL DISORDERS - Medicine for Mountaineering and Other Wilderness Activities - page 252

Mild generalized abdominal tenderness may be present, particularly in the lower abdo-
men, and bowel sounds are usually much louder than normal. Chills and fever are mild or
absent.
Traveler's diarrhea is frequently explosive in onset and is characterized by copious, wa-
tery, foul-smelling stools. The number of stools varies from three or four to as many as
twenty or more in twenty-four hours. Mucus is occasionally present in the stool, particu-
larly when stools are numerous, but pus and blood are absent.
Antimicrobial agents can reduce the incidence of traveler's diarrhea, but physicians are
justifiably reluctant to recommend their routine use. All antibiotics have potentially sig-
nificant side effects. They predispose individuals to the development of invasive bacterial
infections and can induce drug resistance in bacteria, increasing the risk of infection by or-
ganisms that are antibiotic resistant and more dangerous. However, an antibiotic that is not
absorbed and stays in the gastrointestinal tract has been recently developed for traveler's
diarrheaandshortensthedurationofillness.Rifaximin(Xifaxan®)istakenonlyfornonin-
vasivetraveler'sdiarrheatypically duetoenteropathogenic E. coli .Themedication hasnot
been evaluated in individuals under twelve years of age or during pregnancy and should be
avoided by such persons.
An over-the-counter drug, bismuth subsalicylate (Pepto-Bismol®), prevents traveler's
diarrhea in approximately 65 percent of the individuals taking it. The liquid form is so
bulky that its use is impractical, but the tablets are effective (two tablets four times a day).
This drug has no major toxicity and appears considerably safer for prophylactic use than
antimicrobial agents. Aspirin, which is also a salicylate, should not be taken concomitantly
with Pepto-Bismol®.
The essential element of treatment for vomiting and diarrhea is fluid and salt replace-
ment. (The relief of other symptoms, although desirable, is of secondary importance.)
These disorders often produce significant dehydration, although lethal dehydration is un-
common in healthy adults. Worldwide, 3.3 million deaths per year are caused by diarrhea,
80 percent of them in children less than two years old. Vomiting or diarrhea would defin-
itely aggravate the dehydration almost invariably encountered at high altitudes.
Urine volume and color are reliable indicators of dehydration; small volumes (less than
500 ml daily) of dark yellow or orange urine indicate substantial fluid depletion.
Toreplacefluidsandsalts,fruitjuices,broths,andsoupscanbeconsumed.Rehydration
with a sugar-and-salt solution may be more effective. (The sugar is a key ingredient be-
cause it promotes absorption of the salts.) Packaged rehydration salt mixtures are available
forpurchase.Formulasforreplacementsolutionsareprovidedin Table19-1 .Otherscanbe
found in standard references.
Thecomponentsoforalreplacementsolutionscanbepackedinsmallunitsathome,can
be purchased in prepackaged form, or can be made up in the field. The rather crude meas-
urements listed (teaspoons) are sufficiently accurate for anyone with normally function-