Precautions for Patients with Vomiting and Diarrhea Going to the Emergency Department
Patients with vomiting and diarrhea should begin oral rehydration therapy immediately before going to the ED, and should be prepared to provide details about stool frequency, consistency, and associated symptoms to healthcare providers.
Initial Assessment and Preparation Before Going to ED
Self-Assessment for Dehydration
- Check for signs of dehydration:
- Decreased urination
- Dry mouth and mucous membranes
- Sunken eyes
- Decreased tears
- Dizziness or lightheadedness
- Rapid heart rate
- Decreased skin turgor (skin pinch test)
Start Oral Rehydration at Home
- Begin drinking oral rehydration solution (ORS) immediately 1
- For adults: Drink as much ORS as tolerated
- For children:
- Less than 2 years: 50-100 mL after each stool
- Older children: 100-200 mL after each stool 2
Information to Bring to ED
- Duration of illness
- Frequency and consistency of stools
- Presence of blood in stool
- Frequency of vomiting
- Presence of fever or convulsions
- Recent travel history
- Current medications
- Dietary changes or possible food triggers
- Underlying medical conditions 1
Infection Control Precautions
Personal Hygiene
- Wash hands thoroughly with soap and water before leaving home
- Bring hand sanitizer to use in waiting room
- Consider wearing a mask if vomiting to prevent spread 1
Waiting Room Precautions
- Inform triage staff immediately about symptoms
- Request to be seated away from vulnerable populations (infants, elderly, immunocompromised)
- Use designated restrooms for patients with infectious symptoms
- Dispose of any contaminated materials properly 1
Special Considerations
For Children
- Bring extra clothes and diapers
- Continue breastfeeding if applicable
- Avoid milk formula (if using formula, dilute with equal parts water until diarrhea stops) 2
- Bring child's favorite cup or bottle for administering fluids
For Adults Taking Medications
- Be aware of potential drug interactions:
- If taking loperamide (anti-diarrheal), inform ED staff as it may interact with other medications
- Patients on CYP3A4 inhibitors (e.g., itraconazole) or CYP2C8 inhibitors (e.g., gemfibrozil) should avoid loperamide due to increased risk of cardiac adverse reactions 3
- Patients taking ondansetron should inform staff about any heart conditions or medications that prolong QT interval 4
When to Go to ED Immediately
- Signs of severe dehydration (extreme thirst, very dry mouth, little or no urination)
- Blood in stool
- Persistent vomiting (unable to keep down any fluids)
- High fever (>101°F/38.3°C)
- Severe abdominal pain
- Signs of shock (rapid breathing, confusion)
- Infants under 3 months with diarrhea 1, 5
What to Expect in the ED
Triage and Initial Management
- Assessment of dehydration status
- Vital signs monitoring
- Possible laboratory tests (electrolytes, kidney function)
- Stool samples may be collected 1
Treatment Approaches
- Oral rehydration therapy is first-line for mild to moderate dehydration
- Many EDs now implement waiting room oral rehydration protocols 6
- IV fluids for severe dehydration or persistent vomiting
- Typically 20-30 mL/kg of isotonic solution over 1-2 hours 7
- Antiemetics may be given to control vomiting (e.g., ondansetron) 1
- Antimotility agents like loperamide are generally avoided in:
Post-ED Care Planning
Warning Signs to Return to ED
- No improvement within 48 hours
- Worsening symptoms
- Development of new symptoms (abdominal distension, blood in stool)
- Inability to maintain hydration 1
Home Management After ED Visit
- Continue oral rehydration as directed
- Resume age-appropriate diet during or immediately after rehydration
- Avoid spicy foods, coffee, alcohol, and high-sugar foods
- Consider temporary lactose restriction 1
By following these precautions, patients can help ensure appropriate and efficient care when going to the ED with vomiting and diarrhea, while also helping to prevent the spread of potentially infectious agents to other patients and healthcare workers.