Almost everyone has had, or will have, what many people call stomach flu. The technical term for this is “gastroenteritis”, which means irritation of the stomach and the intestines. Although it often goes away by itself in a couple of days (thus the term “24-hour flu”), it sometimes lasts longer—and having it is a miserable experience for everyone concerned. The symptoms can vary depending on the cause of the illness, but the “classic” signs of stomach flu are a combination of diarrhea, fever and vomiting. Vomiting and fever may or may not occur, but diarrhea is almost always part of the picture.
Gastroenteritis in young children is most often due to viral infections. There are many viruses that can produce diarrhea, with or without vomiting, and these include the rotaviruses that people usually see in the wintertime, the enteroviruses that are more common in summer and adenoviruses that can occur year-round but usually cause respiratory problems, although they can cause diarrhea in babies.
Causes of Stomach Flu
A recently identified cause of gastroenteritis is the Norwalk virus and other noroviruses that has been implicated in several outbreaks of gastroenteritis among cruise-ship passengers. Generally, once a particular virus infects you, you aren’t likely to get it again, but there are many viruses around and it takes a while for a person to have all of them.
There are also bacteria that cause gastroenteritis. They aren’t as common in the United States and other countries with well-developed plumbing and sanitation systems. However, bacterial gastroenteritis is seen frequently where sanitation isn’t as good, especially anywhere where drinking water may have been tainted by human or animal waste, including rural areas of the US and other developed countries. Bacterial gastroenteritis can also come from contaminated food (for example, Salmonella outbreaks in potato salad or other egg-based dishes). Bacterial gastroenteritis is rarer than viral, but sometimes won’t go away without antibiotics.
Treatment of Stomach Flu
- Precautions: Although bacterial gastroenteritis is helped by antibiotics, they don’t help in cases of the more common viral gastroenteritis—in fact, antibiotics can cause or worsen diarrhea. Usually specialists try to make sure a child stays properly hydrated, and wait until the virus has run its course.
- Hydration: It is a good idea to drink a lot of fluids. Diarrhea, a very common stomach flu symptom, causes dehydration very quickly. Even after drinking almost 8-10 glasses of water every day, you’re still going to be dehydrated and short of electrolytes. So, get some Gatorade in bulk. Don’t fight the poop soup, just let it go. Your body needs to get rid of that stuff.
- Pedialyte TM: To reiterate, keeping your child well-hydrated is the mainstay of getting him or her over gastroenteritis. Indeed, the most important part of treatment is to give fluids that your child will keep down and absorb. Pedialyte TM and similar “rehydration formulas” consist of water with sugar and certain minerals. The sugar helps provide energy, and the minerals helps the body absorb water better.Unfortunately, Pedialyte doesn’t taste all that good for some people. Sure, there are flavored versions available, but sometimes they aren’t all that great-tasting either. Then again, keep in mind that medicine shouldn’t have to taste good. Other brands of rehydration fluids (Infalyte, Rehydralyte) may taste better to some people; they certainly taste different.
- Pedialyte Cocktail: Many doctors have tried to get children to drink Pedialyte by mixing it with other things. The risk here is that changing the sugar/mineral balance will make the fluids harder to absorb. Unsweetened Kool-Aid is fairly safe, since it contains no sugar. The sugar concentration of, for example, Pepsi Cola, will throw the Pedialyte balance way off—and, in fact, there is so much sugar in most soft drinks that they can act as laxatives and worsen diarrhea. The same holds true for some “sports drinks” (Gatorade is a sports drink, its sugar content is dubious). I haven’t tried mixing diet soda and Pedialyte; that may be all right but might cause problems.
- Rice and Cooking Water: Although some people have occasionally recommended the popular folk remedy of boiling rice in water, pouring off the water, and serving the water (which contains sugars, minerals, and proteins from the rice) to a child with gastroenteritis, it’s no longer advisable as a stomach flu remedy nowadays; there aren’t enough minerals or carbohydrates in the rice water for it to be well-absorbed. Giving rice in the cooking water, however, does seem to help.
- Avoid Plain Water: Another fluid you should avoid with severe gastroenteritis is plain water in large amounts. Plain water is not absorbed as well as water with sugar and minerals. More important, since you lose minerals as well as water in diarrhea and plain water doesn’t make up for the minerals lost, your mineral balances can be thrown way off—possibly to the point of having seizures.
- Simple Diet: Simplifying your diet will help you cure gastroenteritis. Keep your diet down to clear liquids for the first 24 hours (broth, water and juices). If you feel better after 24 hours, then you can move on to foods like white rice, white bread, apple sauce and bananas. Try to avoid citrus, greasy foods, dairy and tomato products, alcohol, coffee and carbonated drinks. In other words, don’t go to McDonald’s.
- Foods to Eat: As most people know, stool consistency depends largely on what kinds of food you eat even under normal circumstances. Eating the right kinds of foods and avoiding the wrong ones can make a big difference in how fast you get over gastroenteritis. Usually clear liquids are the most easily absorbed “food” of all. They also provide extra water (along with minerals) to help prevent dehydration, and they are usually well-tolerated. The best clear liquid is Pedialyte (if your child will actually drink it—see above). Clear soups (like bouillon) don’t work well, because they are often very salty.Tea, even with a little sugar, is actually not very good, since the caffeine in tea is a diuretic (it makes you urinate more—which you don’t want if you’re becoming dehydrated). Heavily sugared drinks, like cola, can actually increase diarrhea by drawing water into the stool (that’s why doctors sometimes recommend corn syrup added to formula as a gentle treatment for constipated babies)—and the caffeine in cola will make you urinate more than usual, just like the caffeine in tea (and coffee). Once your child’s appetite begins to improve, start giving solid foods again.
- Measuring Fluid Intake: If you or your child is vomiting persistently, it’s best not to push fluids very hard—the results can be frustrating (and a mess) for all concerned. You can treat vomiting by waiting about 10-15 minutes after the last feeding attempt, then giving a very small amount of clear liquid (as little as a teaspoon).If this stays down, then give another tablespoon 2-3 minutes later. If that stays down also, then increase the next feeding by 1 teaspoon, and keep increasing the amount until you are giving 2-4 ounces/feeding (depending on your child’s size). If your child throws up a feeding, wait about 15 minutes, then resume at one teaspoon per feeding and work up again. Again, watch the urine output—that’s the best indicator of whether you’re getting enough fluid in.
- Medicine: In regards to medicine for gastroenteritis, don’t overdo it. The diarrhea will usually go away in a few days without medicines if you avoid irritating foods. Over-the-counter diarrhea remedies tend to stop the diarrhea without doing anything about the cause. Remember that doctors have almost no antibiotics for this type of virus. If the problem is a bacterial infection, antibiotics may help, but your doctor has to know what bacteria he or she is dealing with to pick the right antibiotics.Also remember that antibiotics, by changing the bacterial population in the intestines, can cause diarrhea themselves. Most of the antidiarrhea medicines have side effects—some of which can be really nasty. In some rare cases, antidiarrhea medicines may help, but you should ask your doctor before trying any of them.
When to Call for Help
- If you or your child hasn’t urinated for 6 hours or more and you can’t get him or yourself to keep even clear liquids down.
- If you or your child is becoming lethargic or listless. “Lethargic” means that the patient is so out of it that he can’t recognize people he or she usually knows. A patient that can’t recognize his parents and/or loved ones is very lethargic and needs to be seen by a doctor. A “listless” patient is one who isn’t as active as usual—the less active, the more listless.
- If you or your child’s mouth looks dry or his eyes are sunken. These are late signs of dehydration, although usually not as late as true lethargy.
By now you should realize that there isn’t much more you can do about gastroenteritis or the stomach flu than simply treat the symptoms and wait a while before you can get rid of gastroenteritis. So just stock up on Gatorade, Tylenol and a season or two of your favorite sitcom. If your symptoms don’t go away within 48 hours, or if you’re having sharp, localized pains, or if you develop a high fever, or if you have blood in your vomit or in your stool, then it’s a good idea to call your doctor immediately.
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