Viral gastroenteritis (patient information)

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 * Associate Editors-In-Chief: Priyamvada Singh, MBBS [mailto:psingh@perfuse.org]

Overview
Viral gastroenteritis is inflammation of the stomach and intestines from a virus. The infection can lead to diarrhea and vomiting. It is sometimes called the "stomach flu."

What are the symptoms of Viral gastroenteritis?
Other symptoms may include:
 * Abdominal pain
 * Diarrhea
 * Nausea
 * Vomiting
 * Chills
 * Clammy skin
 * Excessive sweating
 * Fever
 * Joint stiffness
 * Leakage (incontinence) of stool
 * Muscle pain
 * Poor feeding
 * Vomiting blood (very rare)
 * Weight loss

What causes Viral gastroenteritis?
Viral gastroenteritis is a leading cause of severe diarrhea in both adults and children. Many types of viruses can cause gastroenteritis. The most common ones are: Those with the highest risk for severe gastroenteritis include the young, the elderly, and people who have suppressed immune systems.
 * Astrovirus
 * Enteric adenovirus
 * Norovirus (also called Norwalk-like virus). It is common among school-age children.
 * Rotavirus, the leading cause of severe gastroenteritis in children. It can also infect adults exposed to children with the virus. Outbreaks may also occur in nursing homes. These viruses are often found in contaminated food or drinking water. Symptoms of viral gastroenteritis usually appear within 4 - 48 hours after exposure to the contaminated food or water.

Who is at highest risk?
It can occur in any age group and is seen frequently in both children and adults

Diagnosis
Your health care provider will look for signs that the body does not have enough water (dehydration). These include: Tests that examine stool samples may be used to identify the specific virus. This is usually not needed for viral gastroenteritis. A stool culture may be done to identify a bacterial cause for diarrhea.
 * Dry or sticky mouth
 * Lethargic or comatose (severe dehydration)
 * Low blood pressure
 * Low or no urine output; concentrated urine appears dark yellow
 * Markedly sunken soft spots (fontanelles) on the top of an infant's head
 * No tears
 * Sunken eyes

Treatment options
The goal of treatment is to prevent dehydration by making sure the body has as much water and fluids as it should. Fluids and electrolytes (salt and minerals) lost through diarrhea or vomiting must be replaced by drinking extra fluids. Even if you are able to eat, you should still drink extra fluids between meals. Food may be offered frequently in small amounts. Suggested foods include: People with diarrhea who are unable to drink fluids because of nausea may need intravenous (directly into a vein) fluids. This is especially true in small children. Antibiotics do not work for viruses. Drugs to slow down the amount of diarrhea (anti-diarrheal medications) should not be given without first talking with your health care provider. They may cause the infection to last longer. DO NOT give these anti-diarrheal medications to children unless directed to do so by a health care provider. People taking water pills (diuretics) who develop diarrhea may be told by their health care provider to stop taking the diuretic during the acute episode. However, DO NOT stop taking any prescription medicine without first talking to your doctor. The risk of dehydration is greatest in infants and young children, so parents should closely monitor the number of wet diapers changed per day when their child is sick. Outlook (Prognosis) Most infections will go away on their own. Children may become severely ill from dehydration caused by diarrhea. Possible Complications Rotavirus causes severe gastroenteritis in infants and young children. Severe dehydration and death can occur in this age group.
 * Older children and adults can drink sports beverages such as Gatorade, but these should not be used for children. Instead, use the electrolyte and fluid replacement solutions or freezer pops available in food and drug stores.
 * Do NOT use fruit juice (including apple juice), sodas or cola (flat or bubbly), Jell-O, or broth. All of these have a lot of sugar, which makes diarrhea worse, and they don't replace lost minerals.
 * Drink small amounts of fluid (2-4 oz.) every 30-60 minutes, rather than trying to force large amounts at one time, which can cause vomiting. Use a teaspoon or syringe for an infant or small child.
 * Breast milk or formula can be continued along with extra fluids. You do NOT need to switch to a soy formula.
 * Cereals, bread, potatoes, lean meats
 * Plain yogurt, bananas, fresh apples
 * Vegetables

What to expect (Outlook/Prognosis)?
Most infections will go away on their own. Children may become severely ill from dehydration caused by diarrhea.

When to seek urgent medical care?
Call your health care provider if diarrhea persists for more than several days or if dehydration occurs. You should also contact your doctor if you or your child has these symptoms:
 * Blood in the stool
 * Confusion
 * Dizziness
 * Dry mouth
 * Feeling faint
 * Nausea
 * No tears when crying
 * No urine for 8 hours or more
 * Sunken appearance to the eyes
 * Sunken soft spot on an infant's head (fontanelle)

Where to find medical care for Viral gastroenteritis?
Directions to Hospitals Treating Viral Gastroenteritis

Possible complications
Rotavirus causes severe gastroenteritis in infants and young children. Severe dehydration and death can occur in this age group.

Prevention of Viral gastroenteritis
Most infectious organisms are transmitted by unwashed hands. The best way to prevent viral gastroenteritis is to handle food properly and wash hands thoroughly after using the toilet. Vaccination to prevent severe rotavirus infection is recommended for infants starting at age 2 months.

Alternative Names
Rotavirus infection; Norwalk virus; Gastroenteritis - viral; Stomach flu