Differential Diagnosis and Management
You are experiencing volume depletion from prolonged vomiting, likely exacerbated by alcohol consumption, and require immediate rehydration with isotonic fluids—either oral rehydration solution if you can tolerate it, or intravenous fluids if vomiting persists. 1
Differential Diagnosis
The most likely diagnoses given your presentation include:
- Acute gastroenteritis (viral or foodborne illness) with alcohol-induced gastritis 2, 3
- Alcohol-related gastritis and dehydration from the 2 beers consumed 2
- Volume depletion from 12+ hours of vomiting with fluid and electrolyte losses 4
- Vestibular disturbance (though less likely given the vomiting duration) 2
- Metabolic derangement from prolonged vomiting (metabolic alkalosis, hypokalemia) 3
Immediate Assessment
Assess your volume depletion severity by checking for these signs—if you have 4 or more, you likely have moderate to severe dehydration: 4
- Confusion or altered mental status
- Difficulty speaking fluently
- Extremity weakness
- Dry mucous membranes
- Dry or furrowed tongue
- Sunken eyes
- Severe postural dizziness (inability to stand) 4
Treatment Algorithm
If You Can Tolerate Oral Fluids:
Start oral rehydration solution (ORS) immediately—this is first-line therapy for mild to moderate dehydration. 1 Commercial ORS products or homemade solutions (water with salt and sugar) should be consumed in small, frequent amounts. 1
- Take small sips frequently rather than large volumes at once 1
- Avoid caffeine, alcohol, fatty or spicy foods 4
- Consider an antiemetic to help tolerate oral fluids 2
If You Cannot Tolerate Oral Fluids:
You need intravenous rehydration with isotonic fluids (normal saline or lactated Ringer's) immediately. 1 This requires emergency department evaluation. 1
- IV fluids should be administered at 20-30 mL/kg over 1-2 hours for rapid rehydration 5
- Continue until symptoms improve and you can tolerate oral intake 5
Antiemetic Management
For persistent vomiting, use a serotonin (5-HT3) antagonist like ondansetron or a dopamine antagonist like metoclopramide to control symptoms and allow oral rehydration. 4, 2
- These medications significantly reduce nausea/vomiting and prevent dehydration, electrolyte imbalance, and need for hospitalization 4
- Antiemetics should be used for the shortest time necessary to control symptoms 2
Red Flags Requiring Immediate Medical Attention
Seek emergency care immediately if you develop: 4
- Inability to keep down any fluids for more than 24 hours
- Severe abdominal pain or distension
- Persistent high fever
- Frank blood in vomit or stool
- Severe postural dizziness preventing standing 4
- Confusion or altered mental status 4
- Signs of severe dehydration (4+ signs listed above) 4
Expected Course
Most acute vomiting from gastroenteritis resolves within 48-72 hours with appropriate rehydration. 4 If symptoms persist beyond 48 hours without improvement or worsen, medical evaluation is mandatory to rule out more serious conditions. 4
Critical Pitfall
The alcohol consumption, while intended to facilitate sleep, likely worsened your gastric irritation and dehydration. 2 Alcohol is a gastric irritant and diuretic that exacerbates fluid losses. Avoid all alcohol until fully recovered. 4