Viral Gastroenteritis may be caused by a variety of viruses but the end result is usually the same. Either you are experiencing the unpleasant symptoms of nausea, vomiting, diarrhea or a combination of the three. As with all illnesses, if your condition is caused by a virus and not bacteria antibiotics are of no use. However, there are certain measures you can take to ensure a less miserable experience and rapid recovery.
I. Medications
There are 4 main medications I may use alone or in combination to treat your gastrointestinal illness:
1)Compazine (the generic name is Prochlorperazine). Take one 10mg Compazine tablet by mouth every six hours. Typically this anti-nausea medication may work fine on its own. but I do not usually prescribe this as first line therapy because of the chances of having a dystonic reaction.
2) Zofran( the generic name is Ondansetron): Take one 4 mg tablet by mouth every 6 hours. This is my first line therapy.
If your condition is severe enough that I prescribe both, I will want you to stagger them in the following way:
Take one Compazine tablet first, wait three hours and take a Zofran. 3 hours after the Zofran you take your second Compazine (as it has now been six hours since your first dose). Three hours after the second Compazine you take your second Zofran. Continue this staggering pattern until your symptoms and illness have resolved.
3)Levsin (the generic name is hyoscyamine). This medication is taken to reduce the “dry heaves” where you are unable to stop vomiting even though nothing remains in your stomach.
Take 1 pill by mouth every 4 hours. This may be taken while you are taking Zofran, Compazine or both as it works by a different mechanism.
4)Probiotics: These are over the counter supplements and they are the “good” bacteria we need in our intestines to maintain our ecology. Viral and bacterial infections and the subsequent diarrhea and vomiting can significantly disrupt our ecology which prolongs the recovery time. There are many brands but most pharmacies carry Culturelle brand , Align or Acidophilus Pearls. I would take 1 pill twice daily until you have recovered and your digestion is back to normal. Probiotics are beneficial on their own and seem to have a positive effect on enhancing our immunity and even improving digestion. I typically have all my patients continue to take 1 pill a day indefinitely after the illness has run its course because of these added benefits. Again, there are many brands but typically, I recommend the brands that have multiple strains of the good bacteria. You can find these in Whole Foods, Mrs. Greens and other health food stores.
II. Rehydration and Diet
The main issue with enduring a gastroenteritis is that you easily become dehydrated. The fact that you are losing fluids from vomiting, diarrhea, not eating and having fevers is something that must be dealt with immediately. The dangers of dehydration are that if it is severe enough your kidneys may be adversely impacted. Additionally you may develop electrolyte imbalances (sodium, potassium, etc.) which can cause muscle weakness, confusion and heart rhythm irregularities.
When you are dehydrated and not eating, your body has no fuel to perform its duties and thus starts breaking itself down. In the process your body produces ketones. Now ketones make you even more weak and nauseated so you vomit more, then produce more ketones and so on. Thus, rehydration is key to breaking that cycle.
By one or a combination of medications above, the goal is to stop the vomiting long enough for you to rehydrate yourself. What I recommend is using a combination of Gatorade and Pedialyte in a half and half combination. These fluids restore electrolytes, provide glucose for fuel and most importantly get absorbed faster than water. In other words, that combination of Gatorade and Pedialyte (or just either one alone) will get absorbed before you vomit the fluid back up. Water alone tends to lay heavy on the stomach and is more
likely to get vomited.
Try to take in 6 ounces of the fluids every hour. Do it slowly at first in small sips as this is less likely to trigger the vomiting. I usually tell patients to get a straw as this sometimes makes it easier to get the fluids down. As you become rehydrated, you will feel much better and you can increase the amount of fluids as tolerated. Ideally you want your urine to become as clear as possible. Dark yellow, concentrated urine indicates you are not fully hydrated.
With respect to diet, hydration comes first, then start slowly with broth, bananas, toast in small amounts and increase as tolerated. Stay away from lactose (milk and other dairy products) for about a week as your body tends to become lactose intolerant for several days until its equilibrium is restored.
In 24-48 hours your body should be responding well, the vomiting should have stopped and you should continue hydrating and advancing your diet to more substantial foods. If you continue vomiting past 24 hours and can’t keep anything down despite the instructions above, or if you stop producing urine, call your physician’s office immediately or report to the nearest ER or Urgent Care center.
