I ate fish tacos, charro beans, chips, and sauce and now have progressive abdominal bloating, nausea, chills, and a low‑grade fever—what is the appropriate management?

Acute Foodborne Gastroenteritis Management

You most likely have acute foodborne gastroenteritis and should focus immediately on oral rehydration with small, frequent sips of oral rehydration solution (ORS) or sports drinks, avoid antimotility agents like loperamide until bacterial infection is ruled out, and seek medical evaluation if you develop bloody diarrhea, worsening fever, signs of severe dehydration, or symptoms persisting beyond 48 hours. 1, 2

Immediate Self-Care Actions

Hydration is your top priority right now. Your constellation of symptoms—bloating, nausea, chills, and low-grade fever following a restaurant meal—suggests acute infectious gastroenteritis, most commonly caused by norovirus (84% of foodborne outbreaks) or bacterial pathogens like Salmonella, Campylobacter, or Shigella. 3

Rehydration Strategy

• Start oral rehydration solution immediately using small volumes (5 mL every minute initially) with a spoon or small cup, as vomiting often improves with gradual fluid replacement. 2
• If commercial ORS is unavailable, use sports drinks or diluted juice as a temporary substitute, though ORS is superior for electrolyte balance. 1, 4
• Replace ongoing losses with approximately 10 mL/kg ORS for each watery stool and 2 mL/kg for each vomiting episode. 1
• Monitor for severe dehydration signs: dizziness when standing, decreased urination, dry mouth, confusion, or rapid heartbeat—these require emergency department evaluation. 1, 2

Dietary Modifications

• Resume eating as soon as you can tolerate it, focusing on bland starches (rice, toast, crackers), bananas, and yogurt. 2, 4
• Avoid lactose-containing products, caffeine, alcohol, spicy foods, and high-fat foods until symptoms resolve, as these worsen diarrhea. 1, 4
• Do not withhold food entirely—early refeeding shortens illness duration. 2

Medication Considerations

What to Avoid Right Now

Do not take loperamide (Imodium) or other antimotility agents at this stage. 1, 4 Your fever suggests possible inflammatory or bacterial diarrhea, and loperamide is contraindicated when fever is present because it can worsen bacterial infections, prolong pathogen shedding, and increase risk of toxic megacolon. 5 The FDA specifically warns against loperamide in febrile diarrhea due to risks of serious cardiac adverse reactions and respiratory depression. 5

Antiemetic Options

• Ondansetron (Zofran) can help control vomiting and facilitate oral rehydration tolerance if nausea prevents fluid intake. 1, 2 This is available by prescription and has been shown to reduce hospitalization rates in acute gastroenteritis. 6

When to Seek Medical Evaluation

You need urgent medical assessment if any of these develop: 1, 2, 4

• Bloody or black stools
• High fever (>101.5°F/38.6°C) or fever persisting beyond 24-48 hours
• Severe abdominal pain or distention
• Signs of severe dehydration (inability to keep fluids down, no urination for 8+ hours, confusion, severe weakness)
• Symptoms worsening after 24 hours or not improving after 48 hours
• More than 6 unformed stools in 24 hours

Consider medical evaluation within 24 hours for: 3

• Persistent fever with your current symptoms, as this warrants evaluation for bacterial pathogens (Salmonella, Shigella, Campylobacter) that may benefit from antibiotics
• If you are immunocompromised, elderly, or have significant underlying medical conditions

Diagnostic Testing Considerations

If you seek medical care, your provider should consider: 3, 1, 4

• Stool culture for bacterial pathogens if you have fever and bloody diarrhea, as antimicrobial therapy may be indicated for Salmonella, Shigella, or Campylobacter
• Complete blood count if severe symptoms persist, as white blood cell count >15,000 cells/mm³ suggests bacterial infection requiring antibiotics
• Clostridium difficile testing only if you've had recent antibiotic exposure (which you haven't mentioned)

Antibiotic Therapy Decision

Empiric antibiotics are NOT routinely recommended for acute watery diarrhea without testing. 2, 4 However, if you develop bloody diarrhea with persistent high fever, your provider may prescribe a fluoroquinolone (ciprofloxacin or levofloxacin) as first-line empiric therapy while awaiting culture results. 1, 2, 7

Critical caveat: Antibiotics should be avoided if Shiga toxin-producing E. coli (STEC) is suspected, as they increase risk of hemolytic uremic syndrome—a life-threatening complication. 2 This is why stool testing before antibiotics is important when bacterial infection is suspected.

Expected Clinical Course

Most foodborne gastroenteritis resolves within 24-72 hours with supportive care alone. 8, 9 Your symptoms should peak within the first 24 hours and gradually improve. Complete resolution typically occurs within 3-7 days. 9, 10

If diarrhea persists beyond 7 days, further investigation for parasitic infections (Giardia, Cryptosporidium) or other causes becomes necessary. 4

Infection Control

• Wash hands thoroughly with soap and water (not just hand sanitizer, as norovirus is alcohol-resistant) after bathroom use and before food preparation
• Avoid preparing food for others until 48 hours after symptoms resolve
• Clean contaminated surfaces with bleach-based cleaners if norovirus is suspected 3