Management of Food Poisoning with Last Vomiting 12 Hours Ago
Resume oral intake immediately with reduced osmolarity oral rehydration solution (ORS) and restart a normal age-appropriate diet now, as the vomiting has resolved and the primary risk is ongoing dehydration from continued diarrhea. 1, 2
Immediate Rehydration Strategy
Begin oral rehydration solution now to replace any existing fluid deficit and ongoing losses from diarrhea. 1, 3, 2
Administer reduced osmolarity ORS (50-90 mEq/L sodium) at 50-100 mL/kg over 2-4 hours if there are signs of mild to moderate dehydration (dry mucous membranes, decreased skin turgor, concentrated urine). 3, 2
Replace ongoing losses continuously: give 10 mL/kg of ORS for each watery stool and 2 mL/kg for each vomiting episode (though vomiting has stopped, continue monitoring). 3, 4, 2
Continue ORS until clinical signs of dehydration are corrected (normal mucous membranes, good skin turgor, adequate urine output). 1, 4
Intravenous fluids are NOT needed unless there is severe dehydration (altered mental status, poor perfusion, prolonged capillary refill), shock, or inability to tolerate oral intake. 1
Nutritional Management
Resume normal eating immediately—do not restrict diet or wait. 1, 2
Start an age-appropriate usual diet right now, as early refeeding (within 12 hours of beginning rehydration) improves nutritional outcomes and reduces illness duration without increasing complications. 1
Continue breastfeeding throughout if applicable. 1
Avoid high-sugar foods and caffeinated beverages, as these worsen diarrhea through osmotic effects. 2
The commonly recommended BRAT diet (bananas, rice, applesauce, toast) has limited supporting evidence and unnecessarily restricts nutrition. 1
Medication Considerations
Antiemetics are not needed since vomiting stopped 12 hours ago. 1, 2
- Ondansetron would only be indicated if vomiting resumes and interferes with oral rehydration (dose: 4-8 mg orally every 8 hours for adults; 0.15-0.2 mg/kg with maximum 4 mg for children >4 years). 1, 3
Antimotility agents (loperamide) may be considered cautiously in adults only if diarrhea is watery without fever or blood. 1
Never use loperamide if the patient is <18 years old, has bloody diarrhea, has fever, or if STEC (Shiga toxin-producing E. coli) infection is suspected, as this can cause toxic megacolon and worsen outcomes. 1, 3
Adult dosing if appropriate: 4 mg initially, then 2 mg after each loose stool (maximum 16 mg/day). 2
Antibiotics are NOT indicated for typical food poisoning without red flags. 3, 4, 2
Empiric antibiotics should be avoided as they promote resistance without benefit in viral gastroenteritis (the most common cause). 3, 4
Antibiotics are contraindicated if STEC is suspected, as they increase hemolytic uremic syndrome risk by up to 50%. 3, 4
Consider antibiotics only if: fever ≥38.5°C with sepsis signs, bloody diarrhea with severe systemic illness, or immunocompromised state with severe symptoms. 3, 2
Monitoring and Red Flags
Reassess hydration status after 2-4 hours of oral rehydration. 3
Watch for warning signs requiring immediate medical evaluation:
Altered mental status, severe weakness, or inability to stand (suggests severe dehydration or electrolyte imbalance). 1, 5
Bloody diarrhea or high fever (≥38.5°C), which may indicate bacterial infection requiring different management. 3, 2
Persistent vomiting that resumes and prevents oral intake. 1, 2
Signs of severe dehydration: sunken eyes, poor skin turgor, dry mucous membranes, decreased urine output, tachycardia. 3, 2
Infection Control
Practice strict hand hygiene to prevent transmission to others. 3, 4, 2
Wash hands thoroughly with soap and water after toilet use, before eating, and before food preparation (alcohol-based sanitizers are less effective against some gastroenteritis viruses). 1, 2
Clean and disinfect contaminated surfaces promptly. 2
Avoid food preparation for others until at least 48 hours after symptoms resolve. 3