What to do for someone with frequent vomiting, left-sided abdominal pain, and feeling cold after taking Gravol (Dimenhydrinate)?

Immediate Assessment and Emergency Department Referral Recommended

This patient requires urgent emergency department evaluation due to frequent vomiting, left-sided abdominal pain, decreased activity level, and feeling cold—a constellation of symptoms that raises concern for serious intra-abdominal pathology including bowel obstruction, mesenteric ischemia, or other surgical emergencies. 1

Critical Red Flags Present

This presentation contains multiple warning signs that mandate immediate medical evaluation:

• Frequent vomiting since 3pm with left-sided abdominal pain suggests possible bowel obstruction, which causes 55-75% of small bowel obstructions and presents with colicky abdominal pain and vomiting 1, 2
• Decreased activity starting at 1800 indicates clinical deterioration and potential hemodynamic compromise 1
• Feeling cold may represent early shock, hypoperfusion, or sepsis—signs that mandate immediate surgical exploration 1, 2
• Gravol (dimenhydrinate) administration has not controlled symptoms, suggesting the underlying pathology is beyond simple gastroenteritis 3

Why Emergency Evaluation Is Essential

Checking vital signs for tachycardia, hypotension, fever, and tachypnea is crucial as these combinations predict serious complications including bowel ischemia or sepsis. 1 The combination of vomiting, abdominal pain, and systemic symptoms (feeling cold, decreased activity) requires:

• Immediate assessment of hemodynamic stability 1
• Focused history for surgical red flags including prior abdominal surgery (85% sensitivity for adhesive bowel obstruction) 1, 2
• Physical examination for abdominal distension and peritoneal signs (rebound tenderness, guarding, rigidity) which indicate possible perforation or bowel necrosis 1, 2
• Laboratory tests including lactate and blood gas analysis to detect bowel ischemia—critical because absence of peritonitis does NOT exclude bowel ischemia 1

Specific Concerns With This Presentation

Left-sided abdominal pain with vomiting raises concern for:

• Small bowel obstruction, which presents with more frequent vomiting that occurs earlier in the course, colicky abdominal pain, and abdominal distension (occurs in 65.3% of cases) 2, 3
• Sigmoid volvulus, particularly suggested by the triad of abdominal pain, constipation, and vomiting 1
• Mesenteric ischemia, where severe abdominal pain out of proportion to physical findings is the hallmark—this requires immediate CT angiography and surgical consultation without delay 1

Bilious vomiting would indicate mechanical obstruction requiring immediate nasogastric decompression and NPO status. 1 The frequency and persistence of vomiting despite antiemetic therapy (Gravol) is concerning for mechanical rather than functional pathology 3.

Critical Diagnostic Steps Needed

The emergency department evaluation should include:

• Complete blood count, electrolytes, renal function, blood gas, and lactate levels to detect bowel ischemia and assess dehydration from vomiting 1
• CT abdomen/pelvis with IV contrast as the definitive test (approximately 90% accuracy) for identifying obstruction, transition points, bowel ischemia, and surgical causes 1, 2
• Plain abdominal radiograph may be obtained initially but has limited sensitivity—negative films do NOT exclude mesenteric ischemia or early obstruction 1
• Serial abdominal exams every 4-6 hours to detect development of peritonitis 1

Management Pending Evaluation

While arranging immediate transport to the emergency department:

• IV fluid resuscitation with aggressive crystalloid administration is crucial for dehydration from vomiting 1
• NPO status should be maintained if bilious vomiting or suspected obstruction 1
• Transportation via ambulance should be considered based on the patient's condition and deteriorating clinical status 4

Common Pitfalls to Avoid

Do not mistake this for simple gastroenteritis. The absence of other family members with vomiting, the presence of left-sided abdominal pain, the clinical deterioration (decreased activity), and systemic symptoms (feeling cold) all argue against viral gastroenteritis 2.

Do not rely on Gravol response to rule out serious pathology. Dimenhydrinate is appropriate for simple nausea and vomiting but does not address underlying surgical emergencies 3, 5. The failure of symptom control after Gravol administration at 1630 further supports the need for urgent evaluation 3.

Tachycardia alone is a critical warning sign and should trigger aggressive investigation, particularly in the context of vomiting and abdominal pain 1. Signs of shock (hypotension, cool extremities, altered mental status) mandate immediate surgical exploration 1, 2.