Acute Care: Injuries and Illnesses
VOMITING & DIARRHEA (GASTROENTERITIS)
What is it?
Gastroenteritis is an inflammation of the lining of the stomach and
intestines due to a variety of causes. Viruses, parasites, bacteria such
as Shigella, Salmonella, Campylobacter, and E.coli, allergic reactions
to certain foods, irritation from overuse of alcohol, or psychological
reactions including fear and anger can all lead to the symptoms of
gastroenteritis. This article pertains to the management of
gastroenteritis caused by common viruses.
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What are the Symptoms?
- Nausea or Vomiting.
- Liquid or loose stools.
- Increased number of stools.
- Headache or body aches.
- Chills with or without fever.
- Cramping abdominal pain and increased intestinal activity.
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How is it treated?
Because it is caused by viruses, there is no effective antibiotic
regimen, and most people with gastroenteritis can recover with treatment
of their symptoms at home. However, diarrhea and vomiting can cause loss
of important body fluids and essential minerals (electrolytes), and
treatment is aimed at dietary management to replace these losses. During
the first 24-36 hours of illness, the best treatment consists of a clear
liquid diet only. Solid food should be avoided during this time period.
Frequent, small amounts of clear liquids are best and should total at
least 2-3 liters per day. If vomiting occurs, wait 1/2 hour after
vomiting and try a few sips of water or ice chips. If these are
tolerated, then progress to other clear liquids.
Clear liquids include:
- 7-Up, Sprite or Ginger Ale
- Powdered fruit-flavored drinks, like
- Dilute juices (apple, grape, cherry or
cranberry avoid citrus juices)
- Clear broth or bouillon
- Decaffeinated tea
- Jello diluted with water
You should avoid caffeine or alcohol as they can increase fluid losses.
The US Centers for Disease Control and Prevention recommends a formula
for self-medication of diarrheal disease that will replace essential
nutrients that are being lost. Prepare 2 separate glasses of the
following and drink alternately from each glass.
Glass #1: 8 oz. of fruit juice, 1/2 tsp. honey or corn syrup, 1
pinch table salt.
Glass #2: 8 oz. water, 1/2 tsp. baking
Acetominophen 325 mg every 4 hours may be
taken to control fever, headaches and body aches.
Aspirin and ibuprofen should be avoided because they may
cause stomach irritation.
Emetrol may be useful in the treatment of nausea and vomiting
and is available without a prescription.
Bismuth sub-salicylate (Pepto-Bismol) 30-60 ml (2 T.)
every 30 minutes for a total of 8 doses may be taken for diarrhea. Bowel
movements will become black and tarry after Pepto Bismol use.
Imodium A-D 2 caplets or 4 tsp.
after first bowel movement followed by 1 caplet or 2
tsps. after each subsequent bowel movement. Do not
exceed 4 caplets or 8 tsp. in a 24 hour period.
Note: Do not use anti-diarrheal medications if fever is greater
than 101 degrees or if blood is present in the stool. These medications
may be helpful in stopping diarrhea, but theoretically may cause more
problems than they solve by retaining toxins and viruses inside the body
rather than allowing their release.
Starting Solid Foods:
As nausea, vomiting, and diarrhea are controlled with
use of a clear liquid diet for 24-36 hours, you should
continue fluid intake, but may begin to add bland,
constipating solids. To prevent a recurrence of
symptoms, a bland diet should be taken for 24-48 hours
before resuming a regular diet.
Constipating solids include:
- Toasted white bread with honey or clear jellyavoid butter or
- Soda crackers.
- White rice (no butter); cream of wheat or rice cereal (no milk).
- Applesauce or bananas.
- Boiled potatoes.
- Baked or broiled fish or poultry without skin or fat.
- Cultured dairy products yogurt, cottage cheese, buttermilk.
Foods to Avoid:
Because the digestive tract is inflamed with
gastro-enteritis, avoiding some foods that may
exacerbate irritation is wise.
Non-cultured dairy products (milk, cheese, ice
- Spicy foods.
- Greasy or fatty foods, including cream soups, beef or pork.
- Alcohol or caffeine.
- Foods containing roughage (whole grains, seeds and nuts, fruits with
skins, raw vegetables).
You may gradually resume your usual diet after 24-48 hours of eating
bland solids if your symptoms are improving. It may take several more
days before normal bowel movements return.
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When do I need to seek medical
You should seek medical attention if you have:
- Persistent abdominal pain, unrelieved by vomiting or passing a bowel
movement. Fever over 101 degrees, not relieved with Tylenol use.
- Vomiting or diarrhea for more than 24 hours without improvement or
more than three times an hour.
- Blood in the vomitus or stools.
- No urination for more than 8 hours.
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Prevention of Gastroenteritis
Wash hands well with soap and water after using the bathroom and before
eating or handling food.
Do not share eating or drinking utensils. Avoid milk,
meat, or egg-based foods (such as mayonnaise) that have
been left unrefrigerated. During preparation of uncooked
meat and poultry thoroughly clean all utensils and work
surfaces before use with other foods. When traveling in
foreign countries, drink only bottled water or bottled
drinks, eat only fruits and vegetables that can be
peeled or have been thoroughly cooked, and avoid
sidewalk food stands.
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