In Reply to: Sick in Bali? posted by akamort on Thursday, 6. January 2011 at 20:25 Bali Time:
Is it travellers sickness or Bali Belly?
In early '07 a qualified nurse had this to say on a public forum (my emphases):-
Most people confuse traveller's diarrhoea with Bali Belly, but they are actually different.
Traveller's diarrhoea occurs with a sudden change in diet - spicy foods, tropical fruits, etc. & usually the body gets used to the changes and soon adapts and your bowel actions will normalise. It's characterized by sudden abdominal cramping & urgent explosive bowel motions. It is fine to use Imodium or Kaomagma to treat this. You should make sure you drink plenty of water to avoid dehydration remembering that you are in the tropics.
Bali Belly is more akin an acute case of gastroenteritis which can be caused by either a bacterial or parasitic infection. It is passed on by the faecal-oral route so good hygiene is vital. It is characterized by abdominal pain which usually comes in waves, by nausea, by vomiting & by diarrhoea. More often than not the victim is bed ridden, feeling too ill to move about and wants to be close to a toilet.
In this instance, it is best to call a doctor, who will likely give you an antiemetic injection like Maxolon or Stemetil to help stop the vomiting & an antibiotic to kill the bug/bacteria.
Treating the Vomiting:
The gut needs to be rested, so do not eat or drink anything for 2 hours, (you can sip enough to keep your mouth moist, but avoid swallowing anything).
Slowly introduce swallowing a few sips of water every 10 minutes or so over the next 2 hours (in small children - a teaspoon of water every 10 minutes). If this is tolerated after 2 hours, you can commence larger drinks & consider replenishing the electrolytes lost with gastrolyte (paedalyte for kids) or similar. Icy poles are a good source of fluids for fussy children. Avoid fruit juices, as they are too acidic & will upset the stomach further. If a child will only drink juice, dilute it as you would cordial.
Do not drink alcohol, as it will dehydrate you further.
If drinks are tolerated over the next 2 hours, you can add bland carbohydrates into your diet - such as dry crackers, rice (easy to get in Bali), potato, white bread, porridge, etc. Do not recommence a normal diet until 24 hours has passed since you last vomited and avoid diary products for another day or so. If vomiting re-occurs go back and recommence the regime from 'sips every 10 minutes'.
If you are unable to hold anything down for 6 hours, call the doctor again - it's time for another antiemetic injection.
Signs of Dehydration:
Mild to slight - decrease in urine output, urine concentrated & sinks to bottom of toilet bowl.
Moderate - dry tongue & lips, no urine output for 8 hours in young children, 12 hours in older children & adults, mild irritability, sunken fontanelle in babies.
Severe - no urine output, tongue sticks to roof of mouth, sunken eyes, sunken fontanelle in babies, no tears when crying, irritable, confused.
Severe dehydration can lead to shock, especially in children so be vigilant looking for signs.
If you or your child shows signs of moderate to severe dehydration, it's time to quickly get yourself or your child off to hospital for medical intervention & IV re-hydration.
Contrary to some advice in recent posts, it is OK to take Imodium when you have Bali Belly, so long as you do not exceed the recommended dosage & keep up your fluid intake. Imodium is widely used in hospitals to treat acute diarrhoea.
It is a MYTH that you need let the diarrhoea run its course - the bugs are not flushed out in your bowel motions, though they may be present in it. It is more important to slow the diarrhoea to avoid dehydration.
Once the diarrhoea has settled & you've had no bowel motions for a couple of days, you can treat it with an increase in your fruit & fibre intake. You can consider aperients such as coloxyl, nulax, etc. but take it easy with the dosage. Less is best.
Naturally, if the symptoms persist, seek medical advice or go to hospital.