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* What is gastroenteritis? * What causes gastroenteritis? * What are the symptoms of gastroenteritis? * Is gastroenteritis a serious illness? * Is the illness contagious? How are these viruses spread? * How does food get contaminated by gastroenteritis viruses? * Where and when does gastroenteritis occur? * Who gets gastroenteritis? * How is gastroenteritis diagnosed? * How is gastroenteritis treated? http://emedicine.medscape.com/article/906999-treatment * Can gastroenteritis be prevented? * Is there a vaccine for gastroenteritis? * Patient Discussions: Gastroenteritis (Stomach Flu) - Effective Treatments * Find a local Gastroenterologist in your town What is viral gastroenteritis? Gastroenteritis means inflammation of the stomach and small and large intestines. Viral gastroenteritis is an infection caused by a variety of viruses that results in vomiting or diarrhea. It is often called the "stomach flu," although it is not caused by the influenza viruses. What causes viral gastroenteritis? Many different viruses can cause gastroenteritis, including rotaviruses; noroviruses; adenoviruses, types 40 and 41; sapoviruses; and astroviruses. Viral gastroenteritis is not caused by bacteria (such as Salmonella species or Escherichia coli), or parasites (such as Giardia lamblia), or by medications, or other medical conditions, although the symptoms may be similar. Your doctor can determine if the diarrhea is caused by a virus or by something else. What are the symptoms of viral gastroenteritis? The main symptoms of viral gastroenteritis are watery diarrhea and vomiting. The affected person may also have headache, fever, and abdominal cramps ("stomach ache"). In general, the symptoms begin 1 to 2 days following infection with a virus that causes gastroenteritis and may last for 1 to 10 days, depending on which virus causes the illness. Is viral gastroenteritis a serious illness? For most people, it is not. People who get viral gastroenteritis almost always recover completely without any long-term problems. Gastroenteritis is a serious illness, however, for persons who are unable to drink enough fluids to replace what they lose through vomiting or diarrhea. Infants, young children, and persons who are unable to care for themselves, such as the disabled or elderly, are at risk for dehydration from loss of fluids. Immune compromised persons are at risk for dehydration because they may get a more serious illness, with greater vomiting or diarrhea. They may need to be hospitalized for treatment to correct or prevent dehydration. Is the illness contagious? How are these viruses spread? Yes, viral gastroenteritis is contagious. The viruses that cause gastroenteritis are spread through close contact with infected persons. Individuals may also become infected by eating or drinking contaminated foods or beverages. How does food get contaminated by gastroenteritis viruses? Food may be contaminated by food preparers or handlers who have viral gastroenteritis, especially if they do not wash their hands regularly after using the bathroom. Shellfish may be contaminated by sewage, and persons who eat raw or undercooked shellfish harvested from contaminated waters may get diarrhea. Drinking water can also be contaminated by sewage and be a source of spread of these viruses. Where and when does viral gastroenteritis occur? Viral gastroenteritis affects people in all parts of the world. Each virus has its own seasonal activity. For example, in the United States, rotavirus and astrovirus infections occur during the cooler months of the year (October to April), whereas adenovirus infections occur throughout the year. Norovirus infections occur year round but tend to increase in cooler months. Norovirus outbreaks can occur in institutional settings, such as schools, child care facilities, and nursing homes, and can occur in other group settings, such as banquet halls, cruise ships, dormitories, and campgrounds. Who gets viral gastroenteritis? Anyone can get it. Viral gastroenteritis occurs in people of all ages and backgrounds. However, some viruses tend to cause diarrheal disease primarily among people in specific age groups. Rotavirus infections are the most common cause of diarrhea in infants and young children under 5 years old. Adenoviruses and astroviruses cause diarrhea mostly in young children, but older children and adults can also be affected. Noroviruses infect persons of all ages, including older children and adults. How is viral gastroenteritis diagnosed? Generally, viral gastroenteritis is diagnosed by a physician on the basis of the symptoms and medical examination of the patient. Rotavirus infection can be diagnosed by laboratory testing of a stool specimen. Tests to detect other viruses that cause gastroenteritis are not in routine use, but the viral gastroenteritis unit at CDC can assist with special analysis based on public health need. How is viral gastroenteritis treated? The most important of treating viral gastroenteritis in children and adults is to prevent severe loss of fluids (dehydration). This treatment should begin at home. Your physician may give you specific instructions about what kinds of fluid to give. CDC recommends that families with infants and young children keep a supply of oral rehydration solution (ORS) at home at all times and use the solution when diarrhea first occurs in the child. ORS is available at pharmacies without a prescription. Follow the written directions on the ORS package, and use clean or boiled water. Medications, including antibiotics (which have no effect on viruses) and other treatments, should be avoided unless specifically recommended by a physician. Can viral gastroenteritis be prevented? Persons can reduce their chance of getting infected by frequent handwashing, prompt disinfection of contaminated surfaces with household chlorine bleach-based cleaners, and prompt washing of soiled articles of clothing. If food or water is thought to be contaminated, it should be avoided. Rotavirus gastroenteritis can also be prevented by vaccines. Is there a vaccine for viral gastroenteritis? Currently there are two licensed rotavirus vaccines available that protect against severe diarrhea from rotavirus infection in infants and young children. These vaccines are given to children in their first year of life with other childhood vaccines. Q. What is vomiting? A. Vomiting is the forceful expulsion of the stomach contents through the mouth. Q. Why do people vomit? A. Vomiting has many different causes. Some of the more common are viral infection, food poisoning, alcohol overdose, alcoholic hangover, morning sickness, motion sickness, gastritis, and reactions to medications. Less common causes are kidney disease, gastrointestinal cancer, intestinal obstruction, concussion, diabetes, appendicitis, and various diseases of the internal organs.1 Q. What's gastritis? A. Gastritis is simply inflammation of the stomach. It is frequently caused by chronic alcoholism, but an attack of gastritis can also be brought about by sudden irritation of the stomach, such as by drinking heavily carbonated soda pop on an empty stomach first thing in the morning. If not relieved by vomiting, gastritis goes away when the stomach next empties, which happens approximately every 20 minutes. Gastritis is what people usually mean when they say "something didn't agree with me." Q. What happens in vomiting? A. First, let's talk about the bodily functions that lead to vomiting. There are three phases to the vomiting act: nausea, retching, and expulsion.2 Vomiting is ordinarily preceded by nausea. It is not unheard of for a person to vomit without feeling nauseated, particularly in cases of sudden injury or sudden shock, such as witnessing an awful sight or breathing a particularly noxious smell. Vomiting that occurs suddenly and without warning is called precipitate vomiting. But most people experience nausea for a period of time before they vomit. FACTOID: In a recent Internet survey, 39 percent reported having experienced precipitate vomiting. NAUSEA Q. What is nausea? A. There is no single accepted definition of nausea in medicine. So each person needs to come up with his or her own. For our purposes, nausea is a feeling in the stomach rhythm that all is not well. Specifically, it is caused by contractions contrary to the normal pattern of contractions within the stomach or perhaps the complete lack of contractions. Ordinarily the immediate effect of nausea is to stop a person from eating or drinking further. If you're not sure you're nauseated -- and there are people like this, as we'll discuss later -- ask yourself "how about some [ice cream, BBQ ribs, orange juice, other favorite food] right now?" If the answer is "sure, why not!" then you are definitely not nauseated. Answering something else might suggest a degree of nausea. Nausea may also include pallor, sweating, excessive salivation, and increased respiration.3 FACTOID: In a recent Internet survey, 63 percent say nausea is worse than vomiting. Q. So if a person is nauseated, will they inevitably vomit? A. Absolutely not! Just as not every person who feels faint will faint, not every instance of nausea will end with vomiting. Just as a yawn means "get some air" and dizziness means "stop moving around," nausea is the body saying "deal with the stimuli causing you to feel this way." Q. What are the stimuli that cause nausea? A. Just about anything can cause nausea! The usual ones are viral illness, food or alcohol poisoning, bodily injury (particularly if the person can see the injury4) unpleasant smells, emotional upset or anxiety, migraine headache, hunger, and medications. FACTOID: In a recent Internet survey, the average person felt nauseated 15.6 times when they did not vomit in the past year. Q. What purpose does nausea serve? A. Nausea is the body's way of teaching a person to avoid the substance or situation that caused it. Although nausea does nothing to remove toxins from the body, it leaves the person with a horrible memory which is apt to be attached to the last thing they ate. Another form of "deal with the stimuli causing you to feel this way." "Nausea and the realization that one is about to vomit are among the most dreadful conditions that man endures." -- American Academy of Family Physicians PHYSIOLOGY OF VOMITING Q. How does a person vomit? A. The stomach is relatively unimportant in the act of vomiting. The brain is in charge, and muscles adjacent to the stomach do the work. The vomiting center is located in the medulla oblongata, the rear part of the brain. This neural center acts on information supplied by the stomach, the intestines, the gag reflex in the throat, the inner ear, and most importantly, the chemoreceptor trigger zone (CTZ), which is located on the floor of the fourth ventricle in the brain, in case anyone cares. The CTZ takes in data about the presence of toxins in the blood and alerts the vomiting center to go to work when it believes the body has been poisoned. The stomach and intestines can signal for vomiting to occur when they are irritated or overloaded. The function of the gag reflex in the throat -- actually the province of something called the constrictor muscle -- is well known. The second phase of the vomiting cycle is retching. The contractions of retching feel much like those of the expulsion phase, but retching too does not lead inevitably to vomiting. The vomiting cycle thus can be halted at any point prior to expulsion. In retching, the respiratory and abdominal muscles contract, forcing the gastric contents into the esophagus, but this is not enough to propel them out of the body. At the rest phases between retches, the stomach contents reflux back into the stomach.5 The key distinction between retching and expulsion is the motion of the diaphragm. When vomiting occurs, it is because the diaphragm relaxed suddenly during the retching cycle, enabling the stomach contents to be expelled through the mouth.6 The muscles that do the work are the diaphragm and the abdominal muscles. When the body is ready to vomit, the pyloric sphincter (which separates the stomach from the duodenum) closes, while about 45 seconds before vomiting,7 the lower esophageal sphincter (which separates the stomach from the esophagus) relaxes greatly, pulling the top of the stomach into the shape of an inverted funnel. The stomach contracts to shift contents from the lower to the upper portion.8 The abdominal muscles tighten, and the diaphragm goes down sharply in one or more contractions, squeezing the stomach. With the usual exit from the stomach closed, the contents have nowhere to go but up. Q. Where exactly is the constrictor muscle? A. The constrictor muscle is in the back of the throat, right behind the uvula. Q. Why does vomit taste so awful? A. It's a myth that stomach acid gives vomit its bad taste. Stomach acid is tasteless, although it does produce a burning sensation if it comes into the mouth through burping, vomiting, or acid reflux. The foul taste of vomit is due to three factors: 1. Vomit contains butyl acid, a chemical produced in the small intestine, which gives vomit its unforgettable smell and taste 2. Vomit consists of digested and partly-digested food -- different kinds of food -- mixed together in ways that no one would ever attempt voluntarily 3. Vomit typically contains no sweeteners; sugars are the first part of food digested, as digestion of them actually begins while they're still in the mouth Q. Why does vomit look like nothing that has been eaten? A. Only vomiting occurring shortly after eating would contain anything looking familiar. By the time the stomach contents have been processed by the small intestine, they become unrecognizable glop. Q. Why is there material from the small intestine in vomit? A. As mentioned above, stomach acid is very strong. One of the main functions of the stomach is to disinfect that which is entering the body, and it uses a powerful level of hydrochloric acid to soak the food sterile. Ask any heartburn sufferer about the power of stomach acid. In an important step approaching the climax of the vomiting process, the vomiting center issues a command to have the small intestine send a fair portion of its contents back into the stomach. This starts about one minute before vomiting and lasts about 45 seconds.9 (For those who cherish bits of trivia, this is called the retrograde great contraction.) This has the effect of neutralizing the vomit,10 making it less damaging to the esophagus, throat, mouth, and teeth. Some researchers contend that expulsion of the intestinal content is a necessary part of the vomiting act in itself [since the intestine is where the toxin was detected by the CTZ], and that the movement into the stomach puts it in place for being ejected.11 The transfer of intestinal matter also increases the volume in the stomach, which makes vomiting easier. Q. Increased volume makes vomiting easier? A. Absolutely. For those who suffer from multiple episodes of vomiting, those later incidents would be soothed greatly if there were material available to be brought up. People who suffer from the "dry heaves" at the end of a vomiting cycle describe them as much more painful and traumatic than the "wet heaves" that open the process. In fact, dry heaves can even damage the esophagus and sphincter, causing bleeding and even tearing. FACTOID: In a recent Internet survey, 34 percent said they vomit only once during a typical illness, 31 percent vomit twice, 21 percent vomit three times, and 13 percent vomit four or more times. The average is 1.82 times per illness with vomiting. Q. How should one vomit? A. Every medical book that has an opinion says that the head should be kept lower than the hips while vomiting. This is to prevent aspiration of the vomit into the lungs. This is especially important while holding a small child who may not know what to do. In practical terms, this means that one should stand upright and bend over so that the mouth is almost in the toilet. Children should be taught to vomit this way. Anecdotal evidence suggests that most people disregard this advice and either kneel or squat in front of the toilet, positions which do nothing to protect one's airway. Despite the common sense of it, it makes no difference in terms of efficiency what position the body is in. Medical researchers trying to learn the best way to remove poisons from the body in emergency treatment experimented with people vomiting in the two positions and found that vomiting while lying prone as opposed to sitting made no difference in the volume of material ejected.12 Q. How did those researchers find 20 people who were willing to be induced to vomit in two different positions? A. Beats me, but you may be interested to know those 20 subjects vomited an average of 660 ml while sitting and 636 ml while horizontal.13 Q. How is vomiting induced? A. The two main ways are stimulation of the constrictor muscle with a finger -- bet you knew that -- and ingestion of syrup of ipecac, which has been the emetic of choice for decades now. In the past, people were urged to induce vomiting using a greater variety of emetics, including salt and mustard powder, which are not as effective as ipecac and which can be poisonous themselves if vomiting does not occur. It's a good idea to keep syrup of ipecac on hand in case the poison center ever tells you to administer it to a poisoning victim. The stuff is available over the counter at any drug store. Q. But isn't ipecac dangerous too? A. Only if it's abused, as by a bulimic using it regularly. Syrup of ipecac is quite safe in emergency administration, partly because the recommended dose -- 30 ml (2 tbsp) -- will cause vomiting in upwards of 99 percent of patients. In fact, as little as 5 ml (1 tsp) will cause vomiting in over 90 percent of people. Q. So why is the recommended dose six times higher? A. Because that 99 percent effectiveness rate is desired, and also because the medical personnel want the patient to vomit repeatedly to ensure that the poison is flushed out completely. Here is an account of an experience with ipecac. Q. What's the time frame for that repeated vomiting? A. Subsequent episodes of vomiting, if they occur, are most likely to come at 20-minute intervals, closely corresponding to the cycle of the stomach in emptying the normal way. Q. How long does it take to vomit? A. About 20 seconds. Each wave typically takes six seconds and there are usually three or four waves. Having all the vomit come up in one wave is rare, making two the minimum. So those subjects mentioned above who brought up about 22 ounces (640 ml) probably had three waves averaging about a cup (8 oz) each. The first wave is almost always the smallest. MOTION SICKNESS Q. You mentioned the inner ear. What's that got to do with vomiting? A. The inner ear is another place that has the ability to detect toxins in the blood. Many people have suffered dizziness at the same time as nausea and vomiting. This heightens the likelihood that the vomiting was caused by food poisoning or some other kind of poisoning. This is also why people experience nausea and vomiting from motion sickness. Q. How so? A. The motion caused by travelling -- especially on a boat -- moves the fluid in the inner ear all kinds of directions at once. As mentioned, one function of the inner ear is to detect poisons in the blood, which cause it to go haywire. In motion sickness, the brain reads the excess stimulation of the inner ear as poisoning, and it responds by causing nausea and vomiting. This was proved by inducing vomiting in dogs by giving them poison. The inner ears of the dogs were then removed and the poison was administered again. None of the dogs vomited. (It is interesting to note that people born as deaf mutes never suffer from motion sickness.) Q. Why is motion sickness more common on a boat than other forms of transport? A. Because on a boat people are moved in three dimensions at once while on air and land people are usually only moving in one or two dimensions at a time. The word "nausea" itself comes from the Greek word for seasickness.14 Q. How can I avoid motion sickness? A. The best way is to plan ahead and take medicine. The most effective is the scopolamine patch, which is worn behind the ear and lasts for days. Most sufferers take Dramamine (or generic equivalent). A more advanced pill is meclezine, sold under the brand names Bonine and Dramamine II. This drug has the advantage of lasting longer than Dramamine and also causing much less drowsiness. The downside of these medications is that they should not be used in conjunction with alcohol, which makes them bad choices for cruise passengers with party spirit. Sea bands, which are worn around the wrist and provide acupressure, are also popular and some believe them to be effective. These are widely available at boat shops, and there's an FDA-approved model available by prescription, ReliefBand. If you're feeling seasick, it's best to get out on deck, preferably near the center. Back at the stern is a good place. Keep an eye on distant objects or the horizon. This page has some pretty good -- and frank -- advice. The important thing to remember is that once you're seasick, there's nothing you can take orally to get well. The vessel's medical officer might give you injections or suppositories after you've been vomiting for a while. Q. But how can anyone get seasick on such a big ship? A. Oh man. Remember this: "It's not the size of the boat, it's the motion of the ocean." If you really have to succumb to your queasiness, some people say vomiting off the side and into the water brings a sense of relief not gained by using the bag. Q. I've seen those bags on airplanes but I've never seen anyone use them. Do people really get airsick? A. The bags are used much more often on boats, but they are definitely used on planes. The airline industry reports that less than one percent of passengers total get airsick to the point of vomiting, but if airsickness starts in a particular plane, the rate jumps to eight percent. Part of that is the power of suggestion. Vomiting on an airplane is a traumatic experience, especially for a child. It's better to use the bag rather than try to make it to the lavatory and find it occupied. PROJECTILE VOMITING, RETCHING, and "DRY HEAVES" Q. What is projectile vomiting? A. Projectile vomiting is that which occurs with so much force that the vomited matter is cast several feet from the body. If it happens after a head injury, it becomes a medical emergency and immediate attention is warranted. It can also be a sign of obstruction of the alimentary canal. Some people project because they build up a lot of pressure in his abdomen by retching repeatedly. Q. Why does projectile vomiting occur? A. As mentioned, sometimes it is due to brain injury and needs to be treated as an emergency. Sometimes it's just a result of the body retching more than is needed. Q. Why is retching needed? Is retching the same as "dry heaves"? A. Physiologically, retching and dry heaves are the same act. Retching is normal to open a vomiting episode; specifically, retching at least once or twice is necessary to "prime the pump," if you will, before vomiting can happen. This is done to build up the pressure needed to expel the stomach contents from the body. As one retches, pressure builds up in the chest. The key event is when the body has retched enough (built up enough pressure) for vomiting to occur, the diaphragm relaxes, and this transfers the pressure that has built up in the chest to the abdomen, and this pressure then expels the stomach contents through the mouth. This kind of retching is usually not referred to as dry heaving; rather, everyone recognizes it as part of vomiting. When a person projectile vomits, essentially there has been too much pressure built up during retching and the additional pressure manifests itself in the vomit being cast farther from the body than normal. What people usually refer to as dry heaves are retches that occur by themselves, generally after one has alrady vomited (although it also occurs before vomiting, or without vomiting), isolated from any vomiting. This is often because there is not enough material left in the stomach to be vomited efficiently. Although it is quite counter-intuitive, one can make this dry heaving less traumatic if one eats or drinks something beforehand (i.e, causes the event to become actual vomiting). FOOD POISONING Q. What is food poisoning? A. Food poisoning is illness caused by tainted or spoiled food. Two of the more-discussed forms of food poisoning are salmonella and e. coli, although staphylococcal food poisoning is probably the most common.15 There are many others, although some are quite rare and only associated with a particular food item, like those caused by shellfish. Q. What causes food poisoning? A. The main causes are failure to keep foods at the proper temperature and improper handling. Tainted properly cooked food is actually rather rare, although cases have been documented where food poisoning was caused by contamination at the farm where it was grown. Since most chicken, eggs, and ground beef arrive at your store already contaminated with either salmonella or e. coli, it is wise to serve these foods well done and to wash hands and utensils thoroughly after handling them. Staphylococcal food poisoning is especially dastardly since killing the staphylococci will do no good if they have already produced toxin. Q. How common is food poisoning? A. No one knows. Some guesses go as high as 20 - 30 million cases annually in the United States. That's one in every 10 people, every year. Q. Why does no one know? A. Because very few people seek medical attention for food poisoning, and even when they do, few of their doctors bother to do lab work, and fewer still report the findings to health agencies. Usually only the clear outbreaks -- when many people who ate the same thing get sick at once -- are investigated. Even a large number of people poisoned won't be detected unless people have some reason to seek medical attention and the medical professionals see a connection. Q. Does all food poisoning result in vomiting? A. No, reasonably little of it results in vomiting. Diarrhea and abdominal cramps are much more common symptoms of food poisoning. Having three or more episodes of diarrhea in an illness, and having bloody diarrhea are good indicators that one has been poisoned. Vomiting is a much more prominent symptom of staphylococcal food poisoning, however. Q. What is the treatment for food poisoning? A. Ceasing ingestion of the contaminated food for starters. Most food poisoning clears itself up within a few days by being flushed from the body by vomiting and diarrhea. It's a good idea to seek medical treatment in case of difficulty swallowing, speaking, or breathing; a prolonged inability to retain fluids; fever over 100 degrees; severe or bloody diarrhea; persistent, localized abdominal pain; or dehydration.17 Q. What is ptomaine poisoning? A. There's no such thing. Decades ago, food poisoning was erroneously believed to be caused by microorganisms called ptomaines, but they are now known to be harmless. GASTROENTERITIS Q. What is the stomach flu? A. "Stomach flu" is actually a misnomer. The term "flu" is short for "influenza," a fairly serious respiratory ailment, and it should properly be used for nothing else. That which people call "stomach flu" is really gastroenteritis, which literally means inflammation of the stomach and intestines. As a result of this abuse of the language, many doctors claim to have no idea what a patient means when complaining of "the flu."18 Q. What causes gastroenteritis? A. Gastroenteritis is ordinarily a viral condition. As with food poisoning, diarrhea is a more common symptom. There is a bit of overlap between food poisoning and gastroenteritis, since many forms of gastroenteritis can be spread through food handling and preparation. One of the most common forms of gastroenteritis -- and one for which vomiting is a more prominent symptom than most -- is the Norwalk virus, which was once called Winter Vomiting Disease.19 Q. Ugh. I'm glad they don't call it that anymore. What's the Norwalk virus? A. Named for the town in Ohio where it was first described,20 Norwalk is only the most common and best known of a group of agents that cause what medical science calls acute epidemic nonbacterial gastroenteritis. It's epidemic because it's so easily spread. In rare cases, dozens of people who live, work, or attend school together can come down with the illness at once. More commonly, Norwalk passes from household to household by one family member picking it up at work or school and infecting other family members. Viruses of this kind are waterborne, which means they can't be spread simply by breathing the same air, like the common cold is. But there's a catch: Once the virus becomes aerosolized in the sneezing or vomiting of an infected person, those tiny water droplets stay in the air for a while and the virus is as airborne as the common cold. In a documented case in England, a girl vomited in a classroom and 48 hours later, 14 other people who were in the room vomited as well.21 In another documented case from England involving adults, someone vomited at a banquet, and three days later, 52 of the 126 guests had come down with Norwalk. The closer the diners were seated to the person who vomited, the more likely they were to become ill. (reference) If a child vomits and the parents who care for the child vomit within a few days, it was probably the Norwalk virus or one of its cousins. So it's easy to see how these gastroenteric viruses can affect many people in a community in the space of a few weeks. Not as dramatic as half the students in a dormitory vomiting in a single night, but still an epidemic nevertheless. Q. How can I keep from catching this awful virus? A. The most important thing is to wash your hands frequently during the winter months or when you're around sick people. It's also good to avoid being where people are smoking since exposure to smoke weakens resistance to the virus. During warm months, stay out of unchlorinated water (rivers and lakes) since the virus is spread easily from bather to bather. Q. How long is a person with Norwalk contagious? A. For two days after the symptoms end. EMETOPHOBIA Q. What is emetophobia? A. Emetophobia is an irrational or excessive fear of vomiting. The author of this FAQ wrote one about emetophobia earlier. You may read more about emetophobia here. Some of the questions answered in the Emetophobia FAQ: * What things do emetophobics do? * How did emetophobics get that way? * Why do phobics fear vomiting? * What happens to emetophobics when they actually vomit? * Why don't emetophobics vomit very often? * What's wrong with emetophobia? * Is there any cure for vomit phobia? * What can emetophobics do for help? FACTOID: In a recent Internet survey, 28 percent of non-emetophobics say they don't mind when someone in their household vomits, and 29 percent don't mind when they see someone vomit in public. But only 9 percent don't mind vomiting themselves and only 3 percent don't mind being nauseated. EMETOPHILIA Q. What is emetophilia? A. Emetophilia is sexual arousal based on vomit or vomiting. Q. Who practices emetophilia? A. There are a variety of forms of emetophilia, and the Internet has shed light on this subject to a far greater extent than has ever been known. Only one medical/psychology article published before the Internet became common discusses the phenomenon.24 Most emetophilics seem to be interested only in discussing their vomiting and that of other people. The next order in the fetish is people who collect pictures of people vomiting. The most occupied emetophilics induce themselves and others to vomit to get sexual highs, and some of these people are the ones making the pictures the others collect. Q. Why are some people aroused by vomiting? A. Vomiting was probably something either arousing or frightening to them at some point prior to puberty. In any case, it aroused powerful emotions, and the emetophilic later called upon these emotions for purpose of sexual gratification. For these reasons, some people have both emetophobia and emetophilia. Q. Is emetophilia why there is so much vomiting in movies and TV these days? A. Probably. Since amateurs make photos and videos of people vomiting, it makes sense that professionals would do it too. Q. Can one tell if a photo or video vomit is real or faked? A. One more thing the vomiting center does in its process is tell the mouth to open. So if the mouth is puckered, the "vomit" is fake. If the mouth is open, there's a chance it's real. Another thing the body does before vomiting is arch the back so that the head is in the proper position. (Holy cow, I bet you didn't know your body does so many things when you vomit!) SURVEY RESEARCH ABOUT VOMITING Q. How often does the average person vomit? A. Two Internet surveys were conducted for this FAQ. A survey of non-emetophobics found that the average person reported vomiting 3.79 times in the past year, although the median was only once. The average person said they vomit 1.28 times in a typical year. The median person most recently vomited five months earlier. When we divide their estimated lifetime episodes of vomiting by their age, we find that the median person vomits .7 times per year, or once every 17 months. The average is much higher, raised by a few prolific vomiters to 1.9 times per year, or once every 6.3 months. Another survey found that emetophobics vomit almost never, with the median emetophobic having most recently vomited 12 1/2 years ago. (Among non-emetophobics, only 8 percent can claim 10 years since their last vomit.) You can learn more about emetophobics and their experience with vomiting here. Q. Are there any gender differences in frequency of vomiting? A. Are there ever! In the survey of non-emetophobics, women reported having vomited 4.9 times on average in the past year, while for men the figure was only 1.4 times. The women said a typical year for them is 1.49 illnesses causing vomiting on average while men reported .9 such illnesses. All of the measures find women vomiting more often than men. The median woman most recently vomited 155 days ago; for the median man, it was 189 days. The differences in the average are even more striking. The average woman most recently vomited just over two years ago while for the average man, it was almost four years. This suggests that being a "non-vomiter" (never or rarely vomiting) is much more common for men than for women. (Bear in mind that emetophobics are excluded from these calculations. Nearly all of them are non-vomiters, and there are more women among them than men.) The average woman claimed to have vomited 93 times in her life, which divided by age works out to 3.1 times per year. The average man reported 30 vomits in his lifetime, or .9 times per year. The median woman reported vomiting 30 times, or 1.1 times per year, and for the median man it was 18 times, or .5 times per year. FACTOID: In a recent Internet survey, 59 percent of non-emetophobic men said vomiting is worse, but 60 percent of non-emetophobic women said nausea is worse. This might help explain why women vomit more often than men. Q. What about geographic differences? Q. What caused those people to vomit? A. The phobics and non-phobics who answered the survey said their most recent attack of vomiting was caused by the following: Viral illness 41% Food poisoning 22% Excess alcohol consumption 12% Self-induced 5% Reaction to medication 4% Motion sickness 2% Other 12% In terms of lifetime causes of vomiting, that is, what has caused them to vomit in their entire lives. Viral illness 70% Alcohol 65% Food poisoning 60% Pregnancy (female) 40% Reaction to medications 39% Motion sickness 38% Surgery/anesthesia 27% Self-induced 11% Induced by another person 5% Other 22% Q. Has everyone vomited at some time? A. It looks like it. In five years of conducting surveys and participating in Internet discussion groups, the author has not once encountered a credible case of a person who has never vomited. (There are some people who have a rare inherited disorder that prevents them from ever vomiting, but that's not the answer you were looking for, right?) The author has encountered many people (see here) who have not vomited since childhood (including himself) but no one who has never vomited even once. Perhaps we can conclude from this that everyone has to vomit during childhood, but some emetophobics can prevent it later in life. PREVENTING VOMITING Q. How can one prevent vomiting? A. The best ways are to wash hands frequently, especially when preparing foods or being around other people; to keep kitchens clean; to eat in clean restaurants; to avoid excess in eating and drinking; and to avoid sick people. Q. I meant when one is already nauseated. A. Oh. As has been mentioned, vomiting is not usually inevitable from nausea. Simply relaxing should be the first line of defense -- much nausea is caused by stress and anxiety. Taking small sips of water will give an indication as to the level of stomach upset. If the water seems to inflame things further, lay off. If a little bit of water doesn't hurt, more shouldn't hurt either. (Sometimes the stomach merely needs to be given something to do, in which case the feeling wasn't true nausea but only hunger.) An escalation of defense might involve taking ginger capsules or Emetrol. Emetrol is really cola syrup, the stuff in your Coke or Pepsi if you took away the carbonated water. If you don't want to buy the stuff -- and it's a little bit expensive -- drinking warm, flat cola (or other soft drinks) is apt to work about as well. (Trouble is, warm, flat, cola is hard to stockpile.) Sucking on ice cubes or an ice pop can help quiet your gag reflex. If you've tried relaxing, water, Emetrol, ginger capsules, ice cubes, and similar remedies, the next step might be to try -- vomiting. It won't be fun, but it will almost certainly cure your nausea. Q. NO! I'm not giving up yet! What can I do? A. It's not well known, but Dramamine (dimenhydrinate), which has been the leading drug for treating motion sickness for generations, is also effective in preventing ordinary vomiting. And Pepto-Bismol, which has been the choice of tourists suffering from diarrhea around the world, is powerful enough in suppressing the vomiting center that it can actually counteract a small dose of syrup of ipecac.25 (In a clinical study, only 20 percent of subjects whose 5 ml dose of ipecac was followed by Pepto-Bismol vomited compared to 90 percent who took a placebo.) Q. But couldn't suppressing the vomiting center mean than poisons that would otherwise be vomited will instead be absorbed and cause damage? A. It's doubtful. One doctor writes that vomiting is practically useless in food poisoning to begin with, because by the time enough poison has been absorbed to trigger vomiting, it's too late for vomiting to do any good.26 And there is a small but fervent clique of emetophobics on the Web who have assiduously avoided vomiting for 5, 10, 20, 30 ... 50 years! They have undoubtedly consumed their share of vomit-inducing poisons. Yet they've suppressed their vomiting centers and remain alive. (See the Emetophobia FAQ for more on this or look up their "vomit streaks.".) One instance where it would definitely be inadvisable to monkey with the vomiting center is in case of alcohol intoxication. Many cases have been documented where drunks have died when they failed to vomit the alcohol that a normal person would have. It's not clear why this is so; in none of the documented cases did the intoxicated person take a drug to prevent vomiting. And of course, if preventing vomiting had been a priority, presumably the person wouldn't have consumed a lethal level of alcohol! If you're concerned about interfering with your body's ability to rid itself of toxins, it would be a good idea to simply let the vomiting center do what it wants. Excess alcohol consumption is the leading cause of vomiting in people between the ages of 14 and 34. Q. Are antacids useful in preventing vomiting? A. Quite the opposite. If you find that taking an antacid reduces your nausea, it is only acting as a placebo. But then a lot of nausea exists only in your head to begin with. As has been mentioned, one function of the stomach is to serve as an acid bath for incoming nutrient. Sometimes the stomach is a bit overzealous in this function, and the acid can become overpowering, especially when the stomach or (usually) the duodenum contain ulcers or the acid makes its way into the esophagus. At these times, taking an antacid can be quite useful in neutralizing the stomach acid. But it is strictly a chemical reaction; the antacid really has no medical effect on the body. So taking an antacid for something other than acid will not help one bit. Q. But you said it was the opposite of useful in preventing vomiting. A. Yes. The side effect of reducing the stomach's acid is reducing the stomach's prophylactic function. In this way, the antacid is minimizing the body's ability to suppress poisons and microorganisms. Usually, the only toxins and microorganisms we have to worry about are the ones that can penetrate the body's defenses. When defenses are down, not only are the usual suspects empowered, but bacteria and poisons normally no match for the stomach can become invasive. Take our old enemy the Norwalk virus. In clinical tests, researchers infected some people with Norwalk -- let's not think about what persuaded people to volunteer for those experiments -- and not all of them came down with the erstwhile Winter Vomiting Disease. In another round, the scientists had the subjects take antacid along with the virus, and all of them vomited. People who take prescription acid blockers like Prilosec also report an increase in the amount of nausea, diarrhea, and vomiting they experience. Q. Yikes! So how can one take antacid and be secure? No illustrationsA. It's best to save antacid for a few hours after eating when the food will have spent that amount of time in the acid bath. If your need for antacid is more urgent, a brand called Gaviscon might be of assistance. It's not really an antacid. It forms a kind of liquid dam that floats on top inside your stomach to keep stomach juices out of the esophagus. That way your esophagus is protected without impairing the stomach's natural defenses. Gaviscon won't really neutralize the acid though, so you might need real antacid later, but by that time, your stomach will be nearly empty. Q. What if I really, absolutely refuse to vomit. Can anything be done? A. Doctors give injections of powerful anti-emetics, namely Compazine, Phenergan, and Tigan to stop vomiting, usually in people who have been suffering from it for a few hours, like those Norwalk sufferers mentioned above. But some emetophobics report that their doctors have given them prescriptions for these drugs in pill form. (No doubt these emetophobics had to hound their physicians and psychiatrists in a major way to get them!) There is also an operation called a fundoplication performed in severe cases of acid reflux. Most people who have them are unable to burp or vomit for the rest of their lives. We are unaware of anyone having a fundoplication due to emetophobia. Q. You said I can't get an injection of the anti-emetic unless I've already been vomiting for hours! That's not fair! A. Hmm... we've heard of emetophobics lie about having been vomiting in order to get a shot that will prevent vomiting. FACTOID: In a recent Internet survey, the average person fights nausea for 33 minutes before giving in and vomiting. The average emetophobic fights nausea for 20 hours! WHEN YOU DON'T FEEL LIKE PREVENTING VOMITING Q. OK. I tried all of that and I'm still nauseated. How can I just put an end to my nausea and vomit? A. Some texts suggest that all vomiting is in a sense voluntary, that it occurs only "after nausea reaches severe and intolerable levels."27 Here's some advice on how to vomit. First of all, it's a bad idea to force yourself to vomit with emetics or direct stimulation of the gag reflex. If your body wants to vomit, it won't need that kind of induction. But ... there are things you can do that are more subtle to give yourself a little push. The thing to do is stop fighting the nausea and let yourself vomit. Since it's easiest to vomit on a full stomach, drinking a glass of water or two is apt to help. If you've been fighting nausea, you've undoubtedly been paying close attention to the movements of the muscles that cause vomiting. You've probably been breathing a lot more shallowly than usual to avoid upsetting your diaphragm. So go ahead and upset your diaphragm. Take a couple of sharp, deep breaths and then a couple more. If you're as nauseated as you say you are, you are apt to vomit quickly. Q. How can I know when I'm so nauseated that vomiting is inevitable? A. As The Doctors Book of Home Remedies II puts it, "if low-key queasiness turns to gotta-go nausea, try to relax -- it is going to happen whether you want it to or not."28 When the mouth waters excessively -- the medical literature calls it hypersalivation -- it's unlikely that you'll be able to turn the tide. (It's a good idea to teach children that they should get to the toilet when they're feeling sick and their mouths water.) And when you feel your tongue lock down (the roof of your mouth is rising too in order to give what's coming more room), you'll be vomiting in less than a minute. Q. Why does my mouth water before I vomit? A. For most people, hypersalivation is their signal that vomiting is imminent, and that's useful. The two most common theories are (1) the saliva is useful in coating the teeth to protect them from the acidity of vomit; and (2) the salivation center in the brain is right next to the vomiting center, and the salivation center gets "cross-talk" from the vomiting center being excited, kind of the way adjacent teeth seem to hurt when you've got a toothache. "If low-key queasiness turns to gotta-go nausea, try to relax -- it is going to happen whether you want it to or not." Q. What's the first thing I should do after vomiting? A. When you or your child experience "wet heaves," you should inspect the vomit to make sure it doesn't contain blood, a fairly rare occurrence. Blood in vomit is usually dark, like coffee grounds. This should be reported to your physician. In the extremely unlikely event it contains fresh blood (which is bright red, of course), this should be considered a medical emergency and dealt with at once. Many people find themselves unable to look at vomit, but if medical intervention becomes necessary for whatever reason, it will be helpful if you can state whether it did or did not contain blood. So it's a good habit to check vomit for blood. Q. Can I get dehydrated from vomiting? A. It's not unheard of, although a normal, healthy adult can vomit for more than a day without serious consequences.29 Dehydration is more common when vomiting occurs in combination with severe diarrhea or prolonged time in the sun. The cure for dehydration is hydration -- water. If one is experiencing diarrhea, it's a good idea to lie flat to keep body fluids from flowing to the intestines. Keep an eye on your urine. Deep yellow is a sign of lack of water.30 . Q. After I vomit, what can be done to prevent it from recurring? A. Nothing by mouth for at least one hour.31 Even a little bit of water could trigger another attack. After a few hours, try some water or light beverage like 7UP. When you're ready to try solid foods, remember BRAT. Not your children! Bananas - Rice - Applesauce - Toast. * What is infectious gastroenteritis? * How does infectious gastroenteritis spread? * Can infectious gastroenteritis be prevented? What is infectious gastroenteritis? Gastrointestinal illness (gastroenteritis) is the inflammation of the stomach and small and large intestines. The main symptoms include vomiting and watery diarrhea. Other symptoms include fever, abdominal cramps, nausea, and headache. Infections causing gastroenteritis can be viral, bacterial, or parasitic in origin. Norovirus is a common cause of viral gastroenteritis found on cruise ships. Types of bacterial gastroenteritis infections include Escherichia coli and salmonella. How does infectious gastroenteritis spread? Infections causing gastroenteritis can be spread by contaminated food or water or through an infected food handler. Individuals who are symptomatic with gastroenteritis can spread illness to others by touching handrails, elevator buttons, and shared utensils, as well as through direct intimate contact with others while they are ill. Can infectious gastroenteritis be prevented? Yes. You can reduce your chance of becoming ill by washing your hands more frequently, keeping your hands away from your mouth, and avoiding any food or water that is thought to have been contaminated. When a higher than expected number of passengers or crew become sick, ships implement additional cleaning procedures and use disinfectants that are targeted to stop the illness. More information on handwashing tips and techniques. * What is the Definition of Viral Gastroenteritis? * Description of Viral Gastroenteritis * Causes of Viral Gastroenteritis * Symptoms of Viral Gastroenteritis * Diagnosis of Viral Gastroenteritis * Treatment for Viral Gastroenteritis * Prevention of Viral Gastroenteritis * What Questions to ask Your Doctor About Viral Gastroenteritis? What is the Definition of Viral Gastroenteritis? Gastroenteritis is the medical term for infections causing inflammation of the stomach and intestines. Viruses are common causes of gastroenteritis. Description of Viral Gastroenteritis Many infections of the digestive tract are lumped under the term gastroenteritis, commonly referred to as "stomach flu." Most cases of gastroenteritis are caused by viruses, although the upset also may be caused by toxic substances, antibiotics or other drugs that alter the natural bacterial population of the lower gastrointestinal tract, or a reaction to certain foods. Bacteria such as salmonella and shigella, and intestinal parasites also may cause gastroenteritis. Viral gastroenteritis takes two major forms: sporadic and epidemic. The sporadic form of viral gastroenteritis induces vomiting, diarrhea, abdominal discomfort, fever, or a combination of these. However, it differs from the epidemic form in a number of important respects: it primarily affects infants and young children under two years of age, and it induces a range of responses that vary from subclinical infection to mild diarrhea, to a severe and occasionally life-threatening, dehydrating illness. Epidemic viral gastroenteritis has acquired various names in medical literature including "winter vomiting disease," "acute infectious nonbacterial gastroenteritis ," "epidemic diarrhea and vomiting," "epidemic collapse," and "epidemic nausea and vomiting." In the lay press, it is frequently referred to as "intestinal flu" or "stomach flu." The last two terms are incorrect and should be avoided. The influenza virus does not cause epidemic viral gastroenteritis but instead is responsible for "the flu," a systemic, febrile (causes a fever) disease that predominantly involves the respiratory tract and not the digestive tract in humans. Causes of Viral Gastroenteritis The primary cause of this problem is the ingestion of food that has been prepared by someone carrying the virus. Symptoms of Viral Gastroenteritis The symptoms caused by these infections include fever, nausea, vomiting, abdominal cramping, and diarrhea. When nausea and vomiting are present, they are usually strongest the first 12 to 24 hours and slowly improve thereafter. In addition, diarrhea and cramping may begin during this 24 hour period or immediately afterward. Diarrhea may last a day or two, or in young children it may last a week or longer. Fever is generally short-lived, lasting one to three days. Diagnosis of Viral Gastroenteritis Diagnosis is based on the symptoms and physical exam. Stool studies may be done to rule out bacterial or parasitic infection. Treatment for Viral Gastroenteritis Viral gastroenteritis cannot be cured by antibiotics. Antibiotics treat bacterial infections. If the underlying cause of the gastroenteritis is viral, antibiotic therapy may prolong the diarrhea. A bland diet consisting of clear liquids, bananas, rice, apples, and toast may be recommended initially, as well as adequate fluid replacement. Elderly or extremely ill persons may have to be hospitalized for intravenous replacement of fluids. A variety of medicines, many of them non-prescription, can ease the effects of stomach cramps and gas pains. Although these agents may be effective in reducing the fluid loss associated with diarrhea, their use does not preclude fluid maintenance and replacement. Common antidiarrheals include Kaopectate, Pepto-Bismol, Imodium, and Lomotil. Certain antidiarrheals may reduce the ability of your intestines to eliminate an infectious agent and may prolong or complicate your condition. Ask your physician for advice. Prevention of Viral Gastroenteritis Washing hands after using the bathroom and before meals may help prevent gastroenteritis. Maintaining a clean kitchen, eating in restaurants where the kitchens are kept clean, washing fresh foods thoroughly, and cooking foods carefully are all safeguards against bacterial and viral infections. What Questions to ask Your Doctor About Viral Gastroenteritis? Is it bacterial or viral gastroenteritis? What is the probable cause of the infection? Is there evidence of dehydration? What treatment do you recommended? What do you recommend to relieve the diarrhea and cramping? * What is diarrhea and acute gastroenteritis? * What causes vomiting and diarrhea? * Are vomiting and diarrhea contagious? * How are vomiting treated and diarrhea treated? * When should I call the doctor? What is diarrhea and acute gastroenteritis? * Diarrhea and acute gastroenteritis is when your child has a case of vomiting and diarrhea. * The symptoms do not last for over 8-12 hours. What causes vomiting and diarrhea? * Vomiting and diarrhea are common symptoms of many illnesses. * Vomiting is usually caused by a virus or from eating food that doesn't sit well in the stomach. * Your child may have vomiting and diarrhea at the same time or just one at a time. * Some infants "spit up" after eating or burping. This is not vomiting. Are vomiting and diarrhea contagious? * Sometimes. Vomiting and diarrhea may be contagious, depending on the illness that causes them. How are vomiting and diarrhea treated? Controlling your child's intake of food and liquid can help stop his vomiting and diarrhea. Vomiting Most vomiting will stop within about 8-12 hours with the right care. Some doctors recommend using an oral rehydration solution (ORS) as described below. Other doctors recommend taking the following steps: * Stop formula and breast feedings. Stop all liquids and solid foods in older children. * Give frequent, small amounts of fluids. Give your child 1 ounce of clear liquids every hour. Have your child take small sips. * Do not use plain water. Special clear liquids called oral rehydration solutions (ORS) are best. * Some doctors say that children over 2 years old can have Gatorade, soda, clear soups, tea, Jell-o, and Popsicles. Ask your doctor. * Do not give your child diet soda, sugar-free drinks, or caffeine. * If your child doesn't vomit after 8-12 hours, add solid foods. For infants, try rice cereal with water or Pedialyte. For toddlers, try dry cereal, dry crackers, or dry toast. * If your infant doesn't vomit after 12 to 24 hours, start breastfeeding or begin giving formula. Some doctors recommend giving half-strength formula for 12 hours, then full-strength after 12 hours. Ask your doctor. * Add food and liquids slowly as your child is able to keep them down. Diarrhea * If there is diarrhea but no vomiting, it's usually okay to give your child milk. * Feed your child a "B-R-A-T" diet for 1 or 2 days. It is made of bananas, rice (cooked white rice, rice cereal, rice cakes), applesauce, and tea or dry toast (no butter or jelly). * Keep your child's diet bland until diarrhea is better. Plain pasta, baked chicken, boiled potatoes, cooked vegetables, and soups are good. * Avoid spicy and fried food. * If diarrhea doesn't get better, limit high-sugar foods like Kool-Aid and apple juice. * Do not use over-the-counter medications until you have checked with the doctor. Oral rehydration solution (ORS) * Vomiting and diarrhea can cause dehydration (loss of fluid in the body). * Your child should drink fluids if he has had vomiting and diarrhea. Drinking in small, frequent sips is best. * Your child might need an ORS (such as Pedialyte or Ricelyte) to help replace body fluids. * Call the doctor to find out which ORS to use. * Give your child the ORS in a dropper, spoon, or cup. * If your child has diarrhea but no vomiting, don't limit how much ORS he drinks. * The doctor can tell you the smallest amount of ORS that is okay to give your child. * Wait 30-60 minutes after your child has last vomited to begin giving him the ORS. Give the ORS in small amounts and often (1 teaspoon a minute). Increase the amount slowly, as your child is able to keep it down. * You can breastfeed and give formula while using the ORS. When should I call the doctor? If you have questions or concerns about your child's condition, call the doctor. If your child is very dehydrated, he needs immediate attention. Call the doctor if… * your child is under 6 months old and has a temperature above 104 degrees F (or 40 degrees C). * your child is under 2 years old and has vomiting or diarrhea. * stomach pain is not better in 2 hours, vomiting is not better in 12 hours, or diarrhea isn't better after 3 days. * your child's mouth is dry, he is bloated, or he won't take liquids. * there is blood in the vomit or diarrhea or bile (yellow-green liquid) in the vomit. * your child has pain with urination, a bad headache, neck pain, or a strange rash. * your child is unable to take the medicine he needs. Go to the emergency room if… * your child is very thirsty. * your child doesn't urinate in 8-12 hours or if your infant doesn't urinate in 4-6 hours. * urine is very dark. * your child is sleeping a lot or has very little energy. * there are no tears when your child cries. Quick Answers * Vomiting and diarrhea are symptoms of many illnesses. * Vomiting and diarrhea are not contagious. * If your child is vomiting, stop all food and liquids. After 30 minutes of not vomiting, begin to add food and liquids slowly as he is able to keep them down. * Feed your child a bland diet if he has diarrhea. * Vomiting and diarrhea can cause dehydration. Dehydration can be treated with an ORS. * Call the doctor if vomiting, diarrhea, or aches and pains do not get better within reasonable time. Go to the emergency room if your child is very dehydrated. What is viral gastroenteritis? Gastroenteritis means inflammation of the stomach and small and large intestines. Viral gastroenteritis is an infection caused by a variety of viruses that results in vomiting or diarrhea. It is often called the "stomach flu," although it is not caused by influenza viruses. What causes viral gastroenteritis? Many different viruses can cause gastroenteritis, including rotaviruses, noroviruses, adenoviruses, sapoviruses, and astroviruses. Some of the viruses causing gastroenteritis are seasonal and occur mainly from October through April. Noroviruses in particular have been implicated recently in many outbreaks in the community, in institutions, on cruise ships, and other group settings. Viral gastroenteritis is not caused by bacteria (such as Salmonella or Escherichia coli) or parasites (such as Giardia), or by medications or other medical conditions, although the symptoms may be similar. What are the symptoms of viral gastroenteritis? The main symptoms of viral gastroenteritis are watery diarrhea and vomiting. The affected person may also have headache, fever, and abdominal cramps ("stomach ache"). In general, the symptoms begin 1 to 2 days following infection and may last for 1 to 10 days, depending on which virus causes the illness. Is viral gastroenteritis a serious illness? For most people, it is not. People who get viral gastroenteritis almost always recover completely without any long-term problems. However persons, such as infants, young children, and those who cannot care for themselves, may be unable to drink enough fluids to replace what they lose through vomiting or diarrhea, and are at risk for dehydration from loss of fluids. Immune compromised persons may also get a more serious illness, with greater vomiting or diarrhea, and may also be at risk for dehydration. Some persons may need to be hospitalized for treatment of dehydration. Is the illness contagious? How are these viruses spread? Yes, viral gastroenteritis is contagious. The viruses that cause gastroenteritis are spread through contact with infected persons or items or surfaces that have come into contact with feces (or vomitus with some viruses such as norovirus) from an infected person. Surfaces contaminated with feces or even small droplets of vomitus may remain infectious for days if not disinfected appropriately. Individuals may also become infected by eating or drinking contaminated foods or beverages. How is viral gastroenteritis diagnosed? Generally, viral gastroenteritis is diagnosed by a physician on the basis of the symptoms and medical examination of the patient. Rotavirus infection can be diagnosed by laboratory testing of a feces specimen. Tests to detect other viruses that cause gastroenteritis are not in routine use, but Orange County Public Health may be able to arrange for testing for norovirus if there is an outbreak or cluster of illness. How is viral gastroenteritis treated? The most important part of treating viral gastroenteritis in children and adults is to prevent severe loss of fluids (dehydration). This treatment should begin at home. Your physician may give you specific instructions about what kinds of fluid to give. Medications, including antibiotics (which have no effect on viruses) and other treatments, should be avoided unless specifically recommended by a physician. How long after illness can someone return to work or school? Viruses causing viral gastroenteritis can be shed in the feces for a couple of weeks after onset of illness, depending on the virus. In general, persons should not return to work or school at least until the diarrhea resolves, although depending on the setting, responsibilities, contact with other persons, and hygiene of the affected individuals, exclusion for a longer time period may be recommended. For example, foodhandlers and healthcare workers should be excluded from work for at least 48 hours following resolution of symptoms of gastroenteritis. Can viral gastroenteritis be prevented? Persons can reduce their chance of getting infected by frequent handwashing, prompt disinfection of contaminated surfaces, and prompt washing of soiled articles of clothing. Please see the section on Cleaning and Disinfection for more information. Handwashing with soap and water is especially important after using the toilet, before eating, when hands are visibly soiled, and after removal of gloves after clean-up of vomitus or feces. Viral Gastroenteritis Questions and Answers about Cleaning and Disinfection What should I use to clean and disinfect contaminated surfaces? Contaminated surfaces should be disinfected promptly with household chlorine bleach- based cleaners, diluted chlorine beach (see below), or U.S. Environmental Protection Agency (EPA) approved disinfectants. Household cleaners or EPA-approved disinfectants should be used according to manufacturer’s recommendations. Diluted household chlorine bleach can be applied to hard, non-porous, environmental surfaces; a minimum concentration of 1000 ppm (generally a dilution of 1 part household bleach solution to 50 parts water) is recommended to be effective against noroviruses. When working with bleach, all recommended safety precautions listed on the manufacturer’s label should be followed. If stored in a clear (translucent) container, the diluted bleach solution must be discarded after 24 hours; if stored in an opaque container, the solution can keep for 30 days. All containers should be clearly labeled and dated. What is the best way to clean contaminated fiber sofas, rugs, etc? The best method to clean contaminated furniture and rugs is not clear. Steam cleaning fabric-covered furniture alone may not achieve the necessary temperature required to get rid of the virus. Any particulate matter should be removed as thoroughly as possible prior to disinfection. Chemical disinfection of soiled areas prior to steam cleaning should be considered. Cleaning with detergent and water followed by liberal use of a disinfectant is another alternative. Test the chemical on a non-obvious area for colorfastness prior to use. If the object does not tolerate the disinfectant, suggested temperatures for steam cleaning are 158 o F for five minutes or 212 o F for one minute. Dry vacuuming is NOT recommended. Are there special recommendations for cleaning contaminated laundry? Contaminated clothing or other items should be bagged as soon as possible at the point of use. Soiled laundry should be handled with minimal agitation to avoid contamination of air, surfaces, and persons. Detergents and cycle times should be suitable for the water temperature chosen, following manufacturer’s recommendations. Disinfection of washing and drying machines is not needed as long as gross soil is removed from items before washing, and proper washing and drying procedures are used. There are no recommendations for specific dryer temperatures or times. It would seem prudent to ensure that laundered items are thoroughly dried. How do you get dehydrated? How do you know if you’re dehydrated? How much water do you need to drink, when to drink? What should we drink? What we shouldn't drink? Can we drink too much water? How do you know your tap water is safe to drink? How about bottled water? How about filters and filtered water? Drinking tips for healthy hydration HOW DO YOU GET DEHYDRATED? Through activities of daily living, the average person loses about 3- 4 liters (about 10-15 cups) of fluid a day in sweat, urine, exhaled air and bowel movement. What is lost must be replaced by the water/ fluid we drink and the food we eat. We lose approximately 1-2 liters of water just from breathing. The evaporation of sweat from the skin accounts for 90% of our cooling ability. Exercise, sweating, diarrhea, temperature, or altitude can significantly increase the amount of water we lose each day. The most common cause of increased water loss is exercise and sweating. Even though we are all at risk of dehydration the people most vulnerable are infants, elderly adults, and athletes. They are either not able to adequately express their thirst sensation or able to detect it and do something in time. HOW DO YOU KNOW IF YOU’RE DEHYDRATED? If you are thirsty, it means your cells are already dehydrated. A dry mouth should be regarded as the last outward sign of dehydration. That’s because thirst does not develop until body fluids are depleted well bellow levels required for optimal functioning. Monitor your urine to make sure you are not dehydrated: * A hydrated body produces clear, colorless urine. * A somewhat dehydrated body produces yellow urine. * A severely dehydrated body produces orange or dark-colored urine. The effects of even mild dehydration include decreased coordination, fatigue, dry skin, decreased urine output, dry mucous membranes in the mouth and nose, blood pressure changes and impairment of judgment. Stress, headache, back pain, allergies, asthma, high blood pressure and many degenerative health problems are the result of UCD (Unintentional Chronic Dehydration). HOW MUCH WATER DO YOU NEED TO DRINK? WHEN TO DRINK? To better determine how much water you need each day, divide your body weight in half. The answer is the approximate number of water ounces you should drink daily. You should drink half of your body weight in ounces. If you weight 200 pounds, you should drink 100 ounces water (3.13 quarts, 2.98 liters or about 10-12 cups of water a day). If you weigh closer to 100 pounds you will need only about 50 ounces of water or about four 12-ounce glasses daily. Individuals who are physically active or live in hot climates may needs to drink more. WHAT SHOULD WE DRINK? WHAT SHOULDN’T WE DRINK? We are designed to drink pure, natural water. * Avoiding sodas/soft drinks to provide your fluid needs. The high sugar content and artificial flavors in soft drinks are harmful to your health. * Tea, coffee, soft drinks contain water, but the diuretics contained in these caffineated beverages flush water out of your body. Don’t count on them to replenish fluid loss. * It is OK to drink them occasionally, but if you drink them constantly and don’t drink enough pure natural water, then you are severely compromising your long-term health. * Natural pure water is the best choice. If you are committed to a healthy lifestyle and long-term health, make water a habit and a priority in your life. CAN WE DRINK TOO MUCH WATER? During intense exercise the kidneys cannot excrete excess water. The extra water moves into the cells, including brain cells. The result can be fatal. For that reason, athletes should estimate how much they should drink by weighing themselves before and after long training runs to see how much they lose, and thus how much water and salt they should replace. The studies that found 13% of the runners tested drank too much water, resulting in abnormally low blood sodium levels. The low sodium levels made many of these people very sick, and close to the point of death. The importance lesson here is to balance your water intake with your sodium intake. HOW DO YOU KNOW IF YOUR TAP WATER IS SAFE TO DRINK? Almost all-municipal water in is of high quality and very drinkable. The best source of specific information about the water quality in your area is your local water supplier. Water suppliers are required to send their customer an annual water quality report. Contact your water supplier to get a copy, or see if your report is posted on line. It is important you know your local sources of water quality, and the quality of your local drinking water. To get facts and information about your tap water, drinking water standards and contaminants, contact your local water supplier. The Environmental Protection Agency (EPA) and American Water Works Association (AWWA) are the two credible institutions that provide information you need regarding quality of your water. EPA website www.epa.gov/safewater AWWA website: www.awwa.org. WHAT ABOUT BOTTLED WATER? Bottled water’s biggest advantage is convenience. The Americans now drink more water from bottles than any other nation. Bottled water in is a $16 billion-a-year industry. EPA sets standards for tap water provided by public water systems. The Food and Drug Administration (FDA) sets bottled water standards based on EPA’s tap water standards. Most bottled water is simply tap water put through conditioning filters to make it taste better. Pepsi’s Aquafina and Coco-Cola Co’s Dasani are both made from purified tap water. This doesn’t make it bad, but is something to consider when adding up cost and benefits. Bottled water is safe to drink if it meets the standards. Contrary to popular belief the FDA does not carefully regulate the bottled water industry; therefore even bottled water can be impure unless it is the right kind of water. There are indeed many right kinds of high-quality bottled water that come from great natural water sources, such as spring, glacier, mineral water. High-quality bottled water may be a desirable option for people with special health needs and those who can afford the price. Just make sure your choice of water does not become a limiting factor to drinking it. If you are drinking less water because of the cost of bottled water, supplement your bottles with reusable bottles or just fill up a previously used bottle with H20 from the tap. WHAT ABOUT FILTER AND FILTERED WATER? It is always wise to get a filter if you are not sure how safe your tap water is. There are many water filter products on the market at many different prices. To shop for a good filter, you need to know what a filter factually reduces, or removes, and what it costs. Ideally, you want water that has been filtered via a reverse osmosis process that removes chemicals, pesticides, heavy metals, chlorine, fluoride, bacteria, and viruses. How do you choose a good filter? It is important you do your own research – ask your local health food store, do on-line research and check the Consumers’ Report for products and prices evaluations. We are not in the business of selling water or any water products; however, here are a couple of recommended sources: The water shop: “The Alkalizer” pure reverse osmosis water filter: www.watershop.com Multipure water filter: www.multipureusa.com DRINKING TIPS FOR HEALTHY HYDRATION: Start your morning’s right: Morning is when you are most full of toxin and dehydrated. Reach for a big glass of water first thing in the morning – even before coffee. This water in the morning really gets the blood flowing. -Drink a glass of water when you get up and another when you go to bed. -Take regular water break breaks. -Avoid relying on sodas to provide your fluid need. -Drink water before and after food; ideally drink a glass of water half an hour before you eat your meal and half an hour after the meal. You can drink water with meals, and drink water anytime your body feels like it. *It is very important you balance your sodium intake with your water consumption. Take 1/4 teaspoon of salt per quart of water - every 4-5 glasses of water. Be sure to get sea salt. The best is Celtic sea salt or Himalayan sea salt, both of which are readily available at any health food store. You should always drink water prior to eating, and after eating, to support the digestive process. The stomach depends on water to help digest food, and lack of water makes it harder for nutrients to be broken down and used as energy. The liver, which dictates where all nutrients go, also needs water to help convert stored fat into usable energy. If you are dehydrated, the kidneys turn to the liver for backup, diminishing the liver’s ability to metabolize stored fat. The resulting reduced blood volume will interfere with your body’s ability to remove toxins and supply your cells with adequate nutrients. Keep a water bottle by your side at all the times. Use either bottled water or tap water, and carry it with you everywhere, to the gym, in your car, to your office. Start by adding water to your daily regiment, during the first week, and then incorporate more as needed. The point is not to wait until you’re thirsty to drink. Keep water flowing before, during and after workout. Don’t forget to balance your water intake with sodium intake. Drink at least 1 liter of water for every 60 minutes of exercise. Drink more if it’s hot. During exercise, such as playing sport on a hot summer day, you can lose up to 2 liters per hour of fluid per hour. Water and a balance salt is your best bet to keep healthy and hydrated. During exercise, it is recommended to replenish fluid at least every 20 minutes. What are the effects of dehydration? What is dehydration? The human body needs water to maintain enough blood and other fluids to function properly. If your body loses substantially more fluids than you are drinking, you become dehydrated. Along with the fluids, your body also loses electrolytes, which are salts normally found in blood, other fluids, and cells. What are the effects of dehydration on children? The early effects of even mild dehydration are significant for health, well being, performance and learning - and in the long term carry a higher risk of a number of health problems and disease states. These include constipation, continence problems, kidney and urinary tract infections, kidney stones, and some cancers. In some scientific studies, a decrease in cancer risk was specifically associated with water, as opposed to any other fluids. What is the definition of dehydration? The lack of adequate body fluids needed for the body to carry on normal functions at an optimal level. Dehydration can be caused by fluid loss (through vomiting, diarrhea or excessive urination), inadequate intake, or a combination of both. The most common cause of dehydration in infants and children is acute gastroenteritis with its associated vomiting and diarrhea. Dehydration is classified as mild, moderate, or severe based on the percentage of body weight lost during the acute illness. What are the symptoms of dehydration? What can be done to prevent dehydration? The important thing is to keep replacing the fluid and body salts. At the first sign of diarrhoea, you must give ORS to the patient. You must give this drink after every loose motion. If you have diarrhoea or vomiting, or if you are not drinking very much, force yourself to begin drinking liquids before you become dehydrated. What are the signs and effects of dehydration?. Frequent headaches, tiredness, constipation and nausea, are all typical symptoms of dehydration. A dry mouth or dry lips are also an indicator that our fluid intake is insufficient. Another useful guide is the colour of urine � it should be straw coloured. Doctors also agree that ongoing mild dehydration does have a negative effect on general well-being. What causes dehydration during exercise? Causes of dehydration include excessive fluid losses due to excessive sweating, inadequate fluid intake, or a combination of these factors. How does dehydration occur? The usual causes of dehydration are a lot of diarrhoea and vomiting. Dehydration can also occur if you do not eat or drink much during an illness or if you do not drink enough during or after strenuous exercise. Medications that cause fluid loss to control excess body fluid (diuretics) are a common long-term cause. How is dehydration treated? If you are mildly dehydrated, you need to drink enough liquid to replace the fluids you have lost. Also, you need to replace the electrolytes (salts) you have lost. Drinking sips of water slowly, along with eating the typical American diet, which is high in salt, will replace fluids and salts you have lost. Nonprescription medicines are available that help replenish fluids and electrolytes. http://www.medicinenet.com/dehydration/article.htm http://www.mayoclinic.com/health/dehydration/DS00561 http://www.medicinenet.com/gastroenteritis/article.htm http://www.nlm.nih.gov/medlineplus/gastroenteritis.html http://emedicine.medscape.com/article/906999-treatment http://emedicine.medscape.com/article/801012-treatment http://www.umm.edu/ency/article/000982trt.htm http://www.emedicinehealth.com/dehydration_in_children/article_em.htm http://www.symptomsofdehydration.com/ http://firstaid.webmd.com/dehydration-in-children-treatment http://healthcaretips.psyphil.com/dehydration-causes-symptoms-treatment-of-dehydration/ |