Duration Health

Abdominal pain

Nausea, vomiting and diarrhea

Introduction

Abdominal pain, nausea and vomiting, and diarrhea are common complaints of travelers and adventurers and frequently occur together. Most of the time, these symptoms are due to benign causes like gas, acid reflux, viral illness, or food poisoning. Sometimes, you can get a bacterial infection of the gut that can be more severe or prolonged and may require antibiotic treatment.

Seek immediate medical care for persistent, unrelenting or severe abdominal pain lasting more than a few hours. Seek immediate medical care for vomiting that does not improve with medication or results in the inability to drink any fluids/maintain hydration. Seek immediate medical care for high fever and/or bloody diarrhea or diarrhea with mucus.

Upper abdominal pain, especially with symptoms such as shortness of breath or sweating, could be signs of a heart problem. Seek medical attention immediately. See the Chest Pain section for more detail.

Treatment

Abdominal Pain

If you have mild upper abdominal pain, heart burn or sour stomach, consider taking famotidine (generic for Pepcid®).

Nausea/Vomiting

For nausea and vomiting due to motion or sea sickness, consider taking dimenhyDRINATE (generic for Dramamine®) or meclizine (generic for Dramamine® Non-Drowsy). If you have nausea or vomiting due to another cause or dimenhyDRINATE does not work for sea/motion sickness, consider taking ondansetron. If you are vomiting and become dehydrated, use the oral rehydration solution, which may hydrate the body better than water alone. Even if you are vomiting, the body will likely absorb some of the solution, helping to improve hydration.

Abdominal pain with nausea and vomiting without diarrhea is concerning and may indicate a more serious cause of your symptoms.

Diarrhea

If you have on-going diarrhea, you may consider using oral rehydration solution to help maintain your hydration. If you have persistent diarrhea and abdominal cramping, loperamide (generic for Imodium®) or bismuth subsalicylate (generic for Pepto-Bismol®) can provide some relief of these symptoms. If diarrhea is persistent, associated with fever, or associated with blood or mucus in the stool, you may have an infection for which antibiotics may be indicated. Consider taking fluoroquinolone antibiotic, such as ciprofloxacin or levofloxacin or another antibiotic called azithromycin. It is usually acceptable to take loperamide (generic for Imodium®) along with an antibiotic for control of symptoms, except in the case of fever and severe bloody diarrhea, in which case antibiotics should be taken alone.

When To Worry

Seek immediate medical care if you have any of the following:

Quick Guide

If you have

  • abdominal pain or burning
  • sour stomach
  • increased belching

You may have

acid reflux

Consider using

famotidine (generic for Pepcid®) 20 mg twice a day as needed

If you have

  • motion sickness with nausea or vomiting

You may have

motion sickness

Consider using

dimenhyDRINATE (generic for Dramamine®) 50 mg every 4-6 hours

OR

meclizine (generic for Dramamine Non-Drowsy®) 25 mg or 50 mg, every 24 hours

If you have

  • nausea
  • vomiting
  • mild upper abdominal pain/cramping

You may have

gastroenteritis

Consider using

ondansetron (generic for Zofran) 4 mg every 8 hours as needed

If you have

  • NO fever
  • watery diarrhea without blood/mucus
  • abdominal cramping with or without vomiting

You may have

gastroenteritis

Consider using

for mild to moderate symptoms: loperamide (generic for Imodium®) 4 mg every 6 hours as needed (do not take for more than 2 days)

OR

bismuth subsalicylate (Pepto-Bismol®) 2-4 caplets every hour as needed. Do not exceed 8 caplets in 24 hours. Use until diarrhea stops but not more than 2 days.

for moderate symptoms: azithromycin 500 mg daily for 3 days

and seek emergency medical care

If you have

  • fever >100.4 degrees
  • diarrhea with streaks of blood or mucus
  • abdominal cramping with or without vomiting

You may have

infectious diarrhea

Consider using

for mild to moderate symptoms: azithromycin 500 mg daily for 3 days

OR

for severe symptoms: ciprofloxacin 500 mg twice a day for 5 days PLUS metronidazole 500 three times a day for 5 days

and seek emergency medical care

If you have any one of

  • worsening abdominal pain
  • pain in right lower abdomen
  • inability to drink fluids
  • absence of diarrhea after a bout of diarrhea
  • decreased urination
  • decreased or absent bowel movements
  • blood in stool
  • lightheadedness, dizziness, fainting
  • confusion or change in mental status

You may have

appendicitis or bowel obstruction or dehydration or sepsis or other emergency

You should

seek emergency medical care

Reference

Ciprofloxacin (generic for Cipro) is a fluoroquinolone antibiotic. It can be used to treat infections in the abdomen. Consider ciprofloxacin for diarrhea with blood or mucous. Ciprofloxacin can be taken with ondansetron, if nausea and/or vomiting accompany abdominal pain or diarrhea. Do not take ciprofloxacin with dairy products such as milk or yogurt, or with calcium-fortified juice. Ciprofloxacin is also used to treat other infections, for example, skin infections, sinus infections, urinary tract infections, and infections with some bioterrorism agents including anthrax.

InfectionMedication

Oral rehydration solution is a mixture of water, sugar, and salt that hydrates faster than water alone. Oral rehydration solutions are used in the developing world to treat severe dehydration, and have been shown in some cases to be just as effective as intravenous fluids in restoring hydration.

GeneralDisposable

Loperamide (generic for Imodium) is an anti-diarrheal medication. It treats diarrhea by slowing movement through the gut. Loperamide can be used for the treatment of acute diarrhea, particularly from an infection.

GeneralMedication

Dimenhydrinate (generic for Dramamine) is used to treat and prevent motion sickness.

TravelMedication

Ondansetron (generic for Zofran) is an anti-nausea medication, and prevents nausea and vomiting. It's in a class of medications called 5-HT3 antagonists that work by tricking the nausea centers in the brain. Ondansetron can be used to treat the symptoms of nausea and vomiting from non-serious causes, such as food poisoning, as well as more serious causes.

GeneralMedication

Metronidazole (generic for Flagyl) is an antiprotozoal and antibiotic, which means it fights bacteria as well as other organisms that cause disease. Metronidazole can be used to treat infections in the abdomen.

InfectionMedication

Azithromycin is an antibiotic. Azithromycin can be used to treat respiratory infections like pneumonia, abdominal infections, ear infections, throat infections, and other infections. It is often used in place of penicillin drugs in people with a penicillin allergy. It has a longer duration of action than other antibiotics, so it is usually given for a shorter course of therapy.

InfectionMedication

Famotidine (generic for Pepcid) is used to treat gastritis (pain or burning in the stomach area) and sometimes used with other medications to treat allergic reactions.

GeneralMedication

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