Reality Health

By Dr. Sara Levine

Dear Dr. Levine,

My entire family recently came down with “ the stomach flu.”  One by one, we all ended up in the emergency room getting intravenous fluids.  The fluids worked like a miracle and within a day, we were each better.  How did these fluids cure the flu? Why weren’t antibiotics given? 

The medical name for what you and your family suffered is acute gastroenteritis.  Acute gastroenteritis is a common cause of illness and death worldwide.  Viruses cause a significant number of cases affecting all age groups. If the illness is caused by a virus, antibiotics will not help.  They are only effective against bacteria, not viruses.

Elderly and infants with gastroenteritis are usually more prone to severe illness. On the other end of the spectrum, some people who become infected with gastroenteritis can even be asymptomatic.  Not  all families have illness so severe that it prompts an emergency room visit.  Usually a few family members become ill, but not everyone. Hand washing is crucial in preventing spread. 

Gastroenteritis causes nausea, vomiting, mild fever, followed by diarrhea. When you lose a lot of fluids from your body by vomiting and having diarrhea, and you are unable to replenish them by drinking, you can become dehydrated.  Your body is weakened by this lack of fluids.  Your blood pressure becomes lower so that your heart has to work harder too.  Once you get to a point of significant dehydration, it becomes even harder to replenish your losses.   Not everyone ends up in the emergency room, though.    It is extremely important to recognize the signs of gastroenteritis, and have a plan to prevent dehydration.

First, it is important to know signs that should make you seek immediate medical attention.  High fevers, significant abdominal or back pain, bloody diarrhea, difficulty staying awake or memory loss/confusion are all very worrisome and should always be considered an emergency, especially in conjunction with vomiting or diarrhea.

More subtle signs of dehydration are thirst, dry mouth, lack of tears (dry eyes), and  decreased urination.  If you do not adequately and aggressively rehydrate, you will then become lightheaded, especially when standing up.  You  begin to feel extremely thirsty, yet you throw up everything you drink. 

To prevent dehydration, make sure you or your child drinks enough fluids to replace those lost in diarrhea and vomiting.  You do not need to gulp down large volumes of fluid to rehydrate.  In fact, smaller amounts are preferable.  Try to keep oral rehydration solutions on hand in your pantry.  These are designed for children who are dehydrated.  They contain water, sugar, and a special mix of mineral salts like sodium and potassium. Some common brands are Pedialyte, Rehydralite,  and Resol.   Sport drinks, broth, and soda so not quite have the correct mix.  Some might even make diarrhea worse.  In a pinch, though, for adults and children older than age two, such fluids are still better than water alone. Wait a few minutes after vomiting to let your stomach settle a bit.  Start by giving 1-2 teaspoons every one to two minutes. This equals about a cup over the course of an hour.  By giving the fluids slowly, you are less likely to cause vomiting. If vomiting occurs again, continue the fluids, as quite a lot will stay down.   If you are doing well, you can slowly give larger sips a bit less often, for example every five minutes.  When the vomiting stops, you can slowly begin regular drinks and  solid foods. Fatty foods and foods high in sugar (and in some cases milk products) can make diarrhea worse.  

Call your doctor if your child is under two and has been ill for more than 12 hours.  No matter what the age, if the vomiting or diarrhea is frequent or very large in amount, this also warrants a medical evaluation.  When in question, give your physician a call.  Sometimes an intervention early in an illness can prevent severe dehydration, and perhaps even prevent a trip to the emergency room.

Sincerely,

Sara Levine, M.D., F.A.A.P.