Vomiting and probable dehydration - when to seek treatment

[LimitIsUp]

18 year old dd started vomiting last night. Was sick two or three times before bed. Since waking this morning she must have vomited x15 or more. She is bringing up bile. She has also had diarrhoea. I wouldn't be unduly worried except that she can't even keep down a single sip of water. She has not passed urine since last night

When she staggers to the bathroom to vomit she feels shaky and weak

Everything I have checked online seems to suggest she seek medical attention due to risk of dehydration. I phoned for a same day telephone appointment this afternoon and the GP was not unduly concerned.

So a couple of hours later I phoned 111. They also seemed not overly worried.

It his NHS gatekeeping. I can't help feeling that in non Covid times she would have been seen

I would have thought that not having urinated for 19 hours and not being able to keep sips of water down is a serious risk for dehydration?

Maybe not

should say : "Is this NHS gatekeeping?"

I was like this once my friend who was a nurse told me to sip sugar water and it really did help and improve things I couldn't even sip water and was being sick with bile

Thanks Lazylockdowner - so just dissolve a teaspoon of sugar in water and sip that?

www.nhs.uk/conditions/Dehydration/

Look at this ^^, it says go to A&E if you haven't urinated all day!
She hasn't urinated all day but GP and 111 apparently not worried

Do I just take her to A&E?

If you google, there are a lot of recipe for rehydration drinks. Also you can buy oral rehydration sachets from chemists.

www.nhs.uk/conditions/dehydration/

Don't take some one who is vomiting to a and e - either sugar water or a dioralyte sachet and sip it , best to have sips straight after vomiting so some gets digested

You're poor dd. Have you tried diarolyte sachets?

"Don't take some one who is vomiting to a and e"

Really, but the actual NHS guidance (linked) says (direct quote):

Call 999 or go to A&E if:
you're feeling unusually tired
you're confused and disorientated
any dizziness when you stand up does not go away
you have not peed all day
your pulse is weak or rapid
you have fits (seizures)
These can be signs of serious dehydration that need urgent treatment.

She is the "you have not peed all day"

You shouldn't attend if she still has D&V, but you do need to speak to a GP about not weeing for so long. Call 111 and ask for the out of hours GP to call. If still no help call a pharmacy and speak to the pharmacist, they'll direct you to the most appropriate care.

To add, I have been to a & e before with dehydration when I had labyrinthitis. I was given a saline drip and an injection to stop the vomiting and some tablets to take home with me (cyclyzine I think?). (The GP had advised me to go.) A & e took it really seriously and I was admitted to an AMU on the second occasion I attended there that same week as it was continuing unfortunately.

Was she this poorly when you called 111, is it worth trying again and explaining how she is now?

Yes she was this poorly when I rang 111 and GP - tbh they didn't seem to give a flying fuck. I am going to A&E I think and they can heap opprobrium on me

They were supposed to have rung back by 6. They haven't

Can she try sucking/chewing ice cubes? I had an HG pregnancy & so was like this (minus the D bit!!) for the majority of the pregnancy🤦🏻‍♀️ so I really feel for her, it's horrible! But that was one of the things I could tolerate... or ice pops? Anything with even a little bit of fluid in.

I got IVs & stuff for dehydration several times in a&e but Ovs didn't have diarrhoea so as PP have said, I'm not sure about a&e in that case... but severe dehydration is really dangerous so you definitely need some medical attention if she's heading that way. Hope she feels better soon 🌸

I would just give rehydration sachets and keep an eye on her tonight. My five year old had this for a couple of days and this was the advice I got from the pharmacist. She was fine after a few days. I am not sure what a&e would do except potentially a drip which is similar to rehydration drinks. I personally would try to avoid a&e if at all possible.

Go to A&E!

I really would prioritise your daughter over the risk to A&E.

If you feel you need to go, just go.

Take her to A & E. Dehydration can cause a kidney injury. She might need an IV drip.

Is it just vomiting? No pervious signs of diabetes, no breathlessness or pear drop breath? It's just way you say she's staggering to the bathroom and so much vomiting. Is she thirsty? I'm sure it's just a bug but it's always worth considering other causes if it's this bad

I get like this regularly with migraine.
To stay out of A&E I normally..
Take buccastem (OTC) if I still have enough saliva to dissolve it and liquid anti emetic. Suck ice chips.
Next home visit from G.P. Anti emetic injection. More ice.
Day three more ice and if still vomiting and not under control A&E for fluids.

Imo you should just take her. Whatever it is she needs fluids. I hate A&E but that's what she needs.

Just smelt her breath - pear drops. Is this a problem

I've just looked up DKA - it says vomiting, fruity breath and frequent urination. She has fruity breath and vomiting but not passing urine

We are in hospital car park deliberating what to do

Did you go to A&E? I think you could go to a walk in or A&E with the symptoms you are describing- dehydration is series

With younger children I recall 15mls of water every 15mins being suggested - so do try that a table spoon or two of water every ten or 15 minutes and see if that is tolerated but also either ring or just go depending on what your local NHS is doing re: visits

Just go in - if you have been worried enough to go there trust yourself & go in -

A and e. Hope she’s ok.

I'm a bit shocked that almost everyone had said to take an 18 year old with a vomiting bug to A&E after only one day of symptoms! I've had this with all my kids as toddlers and always been told to ride it out.

Definitely go in. The fruit breath could just be from starvation ketones so don't jump straight to DKA but definitely get her checked