Care of the Patient with an Abdominal Problem

(Abdominal Pain, Vomiting Diarrhea in Adults & Children)

Abdominal Pain – General Instructions

  1. Abdominal (belly) pain can be caused by many different things. Most will go away on their own, such as stomach flu or a temporary upset stomach. Others will require more tests or procedures.
  2. Based on the assessment in the ED today, your doctor does not feel that you need surgery or admission to hospital.
  3. Your condition may change in the next few hours to days, so return to the ED or call your primary care provider if:
  1. The pain does not go away, becomes more severe, or changes in location
  2. You are continuing to vomit or vomiting is more frequent
  3. You develop a new fever over 38°C (100.4°F) or shaking chills, or if you already had a fever and it will not go away
  4. You see bloodin your vomit, urine or bowel movements (blood in the stools may be bright red or tarry black in appearance)
  5. Your skin or eyes become yellow (jaundiced)
  6. Your abdomenbecomesswollen
  7. You are unable to have a bowel movement or pass gas (fart)
  8. You are not improving as expected.
  1. You may eat and drink. We suggest that you start with clear fluids only, and progress to a normal diet over the next 24-36 hours depending on how you feel.

Vomiting and Diarrhea – General Guidelines

  1. Read the instructions above under “Abdominal Pain – General Instructions”.
  2. Vomiting and diarrhea have many causes including viral and bacterial infections, and food poisoning. Most cases of vomiting and diarrhea will stop by themselves in a short while.
  3. Your main task while you are sick is to try to replace the extra fluid and salts you are losing. This is best accomplished with pre-made oral rehydration fluids, such as Pedialyte or Gastrolyte.
  4. Fluid replacement can also be accomplished with regular household fluids, using the following guidelines:
  5. Avoid alcoholic drinks and caffeinated drinks. Both alcohol and caffeine make you pee more than normal and cause extra fluid loss
  6. Fruit juices, Kool-Aid, and sports drinks (e.g. Gatorade) have a lot of sugar, which can worsen diarrhea. If the patient will not drink the oral rehydration solution, these fluids can be given as long as they are diluted with water to reduce the sugar load
  7. Water can not be the only fluid you drink – it has no salt or sugar to replace what is lost by the body.

Vomiting and Diarrhea – General Guidelines (continued)

  1. If you are nauseous or vomiting, you may use Gravol to help control the symptoms. The dose for you is ______mg every 6 hours.
  2. If you are nauseous or vomiting, small amounts of fluid given frequently will be better tolerated than large amounts.
  3. You may eat if you feel like it, but follow these guidelines:
  4. Start with light, easy to digest foods such as soup and crackers, or toast and progress back to normal foods as you improve
  5. Avoid fatty, fried foods, which will often make you feel sick.
  6. Try to avoid the use of anti-diarrhea medicines (e.g. Immodium, Lomotil, Kaopectate). These medicines do not fix the problem that caused the diarrhea, and may make the illness last longer. Immodium is meant for people who have diarrhea and have to get on an airplane to come home from Mexico, not for people who are at home close to the bathroom.
  7. Return to the ED if:
  8. You are unable to drink fluids despite taking small amounts frequently and using Gravol
  9. You feel dizzy or lightheaded when you sit or stand up.

Vomiting and Diarrhea in Children

  1. Read the instructions above under “Abdominal Pain – General Instructions”, and “Vomiting and Diarrhea – General Guidelines”.
  2. Breastfed children should continue to breastfeed. If the child is vomiting, try to make feedings shorter and more often. A breastfed baby should be given rehydration solution (e.g. Pedialyte) in addition to breastmilk according to the schedule below.
  3. Bottle fed children can continue their normal formula. They should be given rehydration solution (Pedialyte) as a supplement to their usual formula according to the schedule below.
  4. Oral rehydration solution schedule for small children (in addition to usual feeds):
  5. 6 months and younger: 1-3 oz every hour
  6. 6-24 months: 3-4 oz every hour
  7. Over 24 months: 4-8 oz every hour.
  8. Bring your child back to the Emergency department if he or she:
  9. is unable to drink fluids despite taking small amounts frequently and using Gravol
  10. has not urinated for 8-12 hours.

These instructions are not intended to be all-inclusive, and may not cover all possibilities. If a new problem develops, or if you have any further concerns or questions please contact your primary care provider, Telehealth Ontario at (866) 797-0000, or return to the ER.

RoyalVictoriaHospital of Barrie, 201 Georgian Drive, Barrie, OntarioL4M 6M2 (705)728-9802

RVH-3285 (Rev Nov 29, 2006)