DD vomiting bug - A&E?

[HighlandCow78]

DD (19) has had really severe diarrhoea and vomiting for the past 24 hours. Can’t keep anything down whatsoever, at this point I don’t know how she even has any fluid in her tummy to vomit - we’ve tried small sips of electrolytes but 10 mins later they come straight back up again. She’s feeling awful - really weak + dehydrated.

Also has a very high temp of 39.5 degrees, again she can’t keep any paracetamol/ibuprofen down to make her more comfortable

AIBU to take her to A&E? Please be kind - I’ve never seen her so ill before and don’t know what to do. I’m concerned that she’s going to end up needing IV fluids as she isn’t peeing and she’s desperately thirsty

It might be worth ringing 111.
I had very similar symptoms when I was younger - minus the high temperature, it was food poisoning. I was very poorly in hospital. They wouldn't let me leave until my heart rate went down to normal levels. It might be better to talk to someone who can go over symptoms and guide you on what to do next. Or go with your gut instinct.
I do hope she feels better soon.

Norovirus is not airborne... It is fecal-oral route, via contaminated surfaces, and food, unless you happen to ingest micro droplets from someone vomiting next to you.

Thank you.. I’m an AHP so have texted some nurse friends for their advice. Always horrible being on the other side of things!

Might not be brave enough at 19 but... Paracetamol can be absorbed rectally.

Hope she is feeling better soon

If you're looking for opinions then mine is that the majority of people with d&v for 24hours will be gastroenteritis/food poisoning that'll settle itself not needing any input beyond good self care. I've felt awful with gastro before, but the thought of going through those symptoms in a busy waiting room for hours running back and forth to the a&e toilets...

That said, if she's really not passing urine over 12-18 hours or not able to tolerate any fluids at all then thats not the majority of people with gastro. If that's genuinely the case then should be seen (I'm skeptical because we often have people who come in with saying they can't keep anything down and demanding something to get rid of the symptoms - the huge majority actually are drinking perfectly fine and actually by the time they've been seen things are settling down).

It does sound like food poisoning, those symptoms and the reheated rice 🤢 Think it’ll stop soon after that long.
Being in A&E feeling that unwell would be absolutely terrible. You could Phone 111 instead but home comfort is likely to be better while you await medical advice.
Maybe some sips of sugary weak tea if it looks like vom’ing is reducing.

Just seen youre AHP, can you take a set of OBS to reassure yourself one way or the other? Fluid chart monitor how much is going in over 2 hours. Not sure id go as far as measuring output in a relative though!!!

Yes - I’m hesitant to take her as I know she’s better off in bed within close proximity to bucket and toilet… A&E is never pleasant but especially in these circumstances. I’m a HCP myself so don’t want to bring her in unless we absolutely have to!

Can’t tolerate any liquids at all - have tried tiny sips of diluting juice + water, flat coke, ice lollies all to no avail. Within 20 mins she brings it back up. It’s the lack of urinating (14 hours now) and the high temp that I’m really concerned about.

Good idea! Yes, will do that.

Teaspoon of dioralyte every ten mins, even if she pukes she'll be absorbing some. Please don't go to A and E without speaking to them/111/GP first. Might not be the rice ,she and I had similar last week and D's the week before. Never puked so much in our lives, temperature too, I lucked out and didn't have diarrhea but ds and dh did. We all felt better after 24/48 hrs but it took about a week to feel properly right again.

Food poisoning from reheated rice most likely.

Keep getting sips into her. Call 111, don’t take her to A&E

That's ok to bring it up after 20 mins, she will still be absorbing it, she needs to keep drinking.

Not weeing for 14 hours
I would take her to A&E
Sounds like her kidneys maybe struggling

No pee at all for 14 hours... Not a drop? I see why you're pondering heading in. Def check pulse and BP but I think if that's really the situation and it's not a "go away parent I don't want to talk about my pee" then could be more than typical gastro/risk of an aki.

When i had kidney injury due to dehydration all my sats were fine so would not go on this alone

I was thinking more along the lines of food poisoning? She ate some lukewarm reheated rice yesterday - teenagers!! 😩

As it is not contagious, I’d go to A&E. The food poisoning from rice is actually very high risk. She may need IV antibiotics.

If you are an HCP and really worried, listen to your gut (no pun intended). See what the observations suggest, but I'd have a low tolerance for going in (well equipped) at this point. I'd let reception know on arrival and see if there's anywhere separate they could sit/lie her to stop the spread of possible infection.

If you are giving 5mls squash every 5-10 mins and she's still not weeing, I'd probably go in if she is drowsy etc.. When I took my son, they still insisted on trying the fluid challenge first so you may as well try it religiously at home first in case it does help.

Keep sepsis and appendicitis in mind.

Regardless of the reason for the D&V

If she isnt peeing, her kidneys maybe struggling
Just go !

Pulse + BP slightly elevated. I would normally be a bit more relaxed about something like this but it’s worrying that DD herself is concerned

When my kidneys were bad my sats where ok
What are hers? And her temperature ?

Just go to A&E

Yeah, I’d go and as a nurse you can advocate for her.
There is a bacterium that loves to grow on old reheated rice that can cause organ failure…
Not worth the risk.

The main benefit of checking OBS in this instance is that if they're deranged than it can be the last push to definitely go.

It's really not common that D&V 24hr history of, in an otherwise healthy adult would result in a need for treatment - hence the hunting for evidence of a benefit to going to a&e.

If she’s still not passing urine and can’t keep anything down then I would take her as she will probably need IV fluids at a minimum and monitoring for an acute kidney injury.

As a HCP are you familiar with a NEWS score? Have you checked for Sepsis red flags.

hope she’s feeling better soon x

I'd just take her down there at this point. Fourteen hours is a long time to not have a wee for. Not to mention that not passing urine and a very high temperature both raise concern for sepsis.

What also worries me is that she feels concerned about her wellbeing. No doubt she's feeling rubbish with this, but I've never thought I was seriously unwell and been mistaken. Unless she suffers from health anxiety, I'd pay attention to her gut feeling (no pun intended!)

Can your daughter take tiny teaspoons of water? At this stage I'd be inclined to be giving that to her every ten mins and keeping a check on her temperature.

Elevated heart rate can be due to infection or dehydration or both.

I think there are a number of things that justify a visit to A&E. Not peeing. Very high temp. Significant vomiting. Elevated pulse and BP.

All these things can be a typical stomach bug / food poisoning, but the problem is they can change rapidly, especially if a bacterial infection.

I wish her well x