The other day I had a female patient that was truly miserable.
Not the tragic, immense loss-type of miserable.
No, this was the “I have four children under the age of 12 at home and they all have vomiting and diarrhea and today I started to have the same symptoms too” type of misery. Recently, I have seen a LOT of this in the emergency department. Gasteroenteritis (“technical” term for the stomach flu) often peaks in the winter and is also caused by episodic outbreaks. New York City saw a 50% increase over the holidays. You may have even seen the news yesterday of a cruise ship that was forbidden from its scheduled docking at the Falkland Islands due to an onboard stomach flu outbreak.
While having an illness where your body seems to be assaulting you from both “ends” of your gastrointestinal system may be one of the most helpless and…well…gross… conditions, there are a few things that you can do to minimize your misery during this time. Wash your hands, don’t share food, start hydrating AS SOON AS symptoms start in order to prevent dehydration, and if you keep vomiting, talk to your doctor about getting a prescription for anti-nausea/vomiting medications. Read below for more details and suggestions!
How it’s transmitted:
The most common causes of gastroenteritis are viruses: rotavirus, adenovirus, and norovirus. Unfortunately, these are VERY hardy bugs—notoriously difficult to eradicate, and only 10-18 virus particles are needed for infection. They can be transmitted on infected surfaces, as airborne droplets, in food, water, and hands. The best prevention is through meticulous hand-washing with soap—decreasing the risk of infection by 50%. Alcohol-based sanitizers are also a great resource.
- Onset of symptoms usually starts 24-48 hours after infection, usually abrupt.
- Most patients have vomiting and diarrhea (4-8 bouts of diarrhea per day), but some have only one of these
- Most patients also have generalized body aches, headache, and just feel plain awful
- 50% have a mild/moderate fever with a temperature of 101-102F
- In most patients, the illness runs its course after 2-3 days, with a full and rapid recovery
Treatment: The primary therapy is to keep well-hydrated to allow one’s body time to heal itself. Infants, elderly, and debilitated people are at higher risk of dehydration, so need close attention.
Once dehydration starts, a vicious cycle begins: mild dehydration –> lethargy, mild abdominal pain, and nausea so drink even less —> vomiting/diarrhea continues –> worsened dehydration –> drink even less fluids –> ER visit for intravenous fluids (that possibly could have been prevented with early fluids)
(1) Oral rehydration: I advise all of my patients, especially parents of children, to start a rehydration fluid AS SOON AS they start to have symptoms of gastroenteritis to prevent the vicious cycle.
As long as you are able to keep down fluids, then this should be your #1 priority. Some patients come worried because their children are not eating regular meals during this time—but that’s ok, as long as they are drinking adequate fluids.
Fluids that are made specifically for rehydration are the “Oral Rehydration Solutions”, which were first pioneered by the World Health Organization. These include the official WHO ORS, but also more commercially available ones such as Pedialyte, Ceralyte, Enfalyte, and Rehydralyte.
- Gatorade/Powerade are not equivalent to these fluids, (sports drink are made to replace fluid losses from sweat, not from gastroenteritis), but may be sufficient if you’re not already dehydrated
- diluted fruit juice and saltine crackers or broth may also be adequate if you are not severely ill
(2) Pepto bismol / Kaopectate / Maalox: These can help in decreasing the severity of abdominal cramping. However, they will not affect the severity/duration of the diarrhea.
(3) Acetaminophen (Tylenol brand): great for the various body aches and headache associated with this illness
(4) Prescription anti-nausea medications: If a patient cannot keep down fluids because of vomiting, but is not so sick that they need to be in the hospital, I often prescribe a short-course of anti-nausea/vomiting medicine. I’ve had many a friend and patient go from curled up in a miserable ball to sitting up, alert, and drinking gingerale simply after alleviating their vomiting. Once they can stop vomiting, they can keep down the necessary fluid, and it makes a WORLD of difference. Speak to your doctor about getting a prescription for one of these medicine, which include Reglan, Zofran, and Compazine.
(5) Diet: Once you can keep down fluids and are sufficiently rehydrated, slowly start to add back food into your diet.
- Breastfed infants: The CDC advocates that once an infant has been rehydrated, they can be restarted on breast-feeding, which can actually reduce the volume and duration of symptoms.
- Older infants, children, and adults: avoid foods with high levels of fat and simple sugars, sticking to complex carbohydrates, lean meats, yogurts, fruits and vegetables if you are able to tolerate them. If even those things make your stomach worse, stick to the “BRAT” diet (bananas, rice, applesauce, and toast), although it’s not absolutely necessary.
When to seek care from a physician: I have found that most of the patients that come to the emergency department simply need medicine to prevent vomiting and hydration (either intravenous or by mouth). However, a small proportion of patients could develop more severe illness, so seek medical care if you see the following:
- signs of dehydration:
- in children: very dry mouth and eyes, no urine/wet diapers for 4-6 hrs in babies/young children, or 6-8 hrs in older children, no tears when crying, sunken circles around eyes
- in adults: significant dizziness, having a very dry tongue or mouth, significant muscle cramps, confusion, urine that is dark yellow, or not needing to urinate for several hours
- blood or mucus in stool
- fever >101.3F
- severe abdominal pain
- recent antibiotic use or hospitalization
- unable to keep down any fluid due to vomiting
- elderly, children less than one year, and patients with underlying severe illnesses or compromised immune systems are at higher risk of getting more sick, and should be evaluated sooner if they have any problems