Category: Health & Safety

Managing Vomiting & Diarrhea Safely

Vomiting and diarrhea are common symptoms of stomach viruses, foodborne illness, medication side effects, and other health problems. Many cases improve on their own within a few days, but repeated vomiting or frequent watery stools can cause dehydration and loss of important electrolytes.

The main goals are to replace lost fluids, monitor the person’s condition, prevent the illness from spreading, and recognize warning signs that require medical care.

Babies, young children, older adults, pregnant people, and people with ongoing medical conditions can become seriously dehydrated more quickly. When someone is medically vulnerable or appears unusually ill, contact a healthcare professional sooner.

Begin by Checking for Emergency Warning Signs

Call 911 or your local emergency number if the person:

• Is unconscious or difficult to wake
• Is severely confused
• Has severe difficulty breathing
• Has collapsed or cannot stand safely
• Has a seizure
• Has severe or rapidly worsening abdominal pain
• Is vomiting a large amount of blood
• Has signs of shock, such as pale or clammy skin, rapid breathing, extreme weakness, or confusion
• May have swallowed a poison or overdosed on medication
• Has a rigid or severely swollen abdomen
• Has severe dehydration and cannot safely be transported

Do not give food, drinks, or oral medication to someone who is unconscious, extremely confused, actively having a seizure, or unable to swallow safely.

Watch for Dehydration

Vomiting and diarrhea cause the body to lose water and electrolytes. Dehydration can develop even when the person does not feel very thirsty.

Possible signs include:

• Dry mouth or tongue
• Increased thirst
• Dark yellow urine
• Urinating less often
• Little or no urine
• Dizziness when standing
• Weakness
• Headache
• Rapid heartbeat
• Sunken eyes
• Unusual sleepiness
• Irritability or confusion
• Few or no tears when crying
• Fewer wet diapers in an infant

Severe dehydration may require intravenous fluids in a hospital or medical facility.

The Centers for Disease Control and Prevention identifies decreased urination, dry mouth, dizziness when standing, reduced tears, and unusual sleepiness or fussiness as important dehydration warning signs. CDC: About Norovirus

Replace Fluids Slowly

A person who is actively vomiting may not be able to tolerate an entire glass of water. Large amounts can stretch the stomach and trigger additional vomiting.

Instead:

1. Allow the stomach to rest briefly after vomiting.
2. Begin with small, frequent sips.
3. Increase the amount gradually if the fluid stays down.
4. Return to smaller amounts if vomiting happens again.

A teaspoon, medicine cup, straw, ice chip, or spoon may make small amounts easier to manage.

Do not force someone to drink quickly. The goal is a steady intake over time.

Helpful Resources: Browse Meals & Hydration Support for products, equipment, services, or supplies related to this section.

Use an Oral Rehydration Solution When Needed

An oral rehydration solution contains a specific balance of water, sugar, and electrolytes designed to help the body replace what has been lost.

Commercial oral rehydration solutions may be especially helpful for:

• Infants and children
• Older adults
• People with frequent diarrhea
• People showing mild signs of dehydration
• People who cannot eat normally
• Anyone advised to use one by a healthcare professional

Use the product according to its directions. Do not dilute a ready-to-drink solution or make powdered solution with more or less water than instructed.

Avoid homemade mixtures unless a qualified healthcare professional or public health authority provides an exact recipe. Too much salt or sugar can make the solution unsafe.

The National Institute of Diabetes and Digestive and Kidney Diseases recommends replacing lost fluids and electrolytes and identifies commercial oral rehydration solutions as particularly useful for children, older adults, people with weakened immune systems, and those with significant diarrhea or dehydration. NIDDK: Treatment for Food Poisoning

Choosing Other Fluids

For an otherwise healthy adult with mild symptoms, useful fluids may include:

• Water
• Broth
• Diluted juice
• Oral rehydration solution
• Ice chips
• Other noncaffeinated fluids

Some sports drinks may help an adult with mild fluid loss, but they may contain more sugar and a different electrolyte balance than an oral rehydration solution. They are not always the best choice for young children or significant dehydration.

Avoid or limit:

• Alcohol
• Large amounts of caffeine
• Very sugary drinks
• Undiluted fruit juice
• Energy drinks
• Large amounts of carbonated beverages

Very sugary beverages can make diarrhea worse for some people.

People with diabetes, kidney disease, heart failure, or fluid restrictions should ask a healthcare professional how much and what type of fluid to consume.

Vomiting in Infants and Children

Infants and young children can become dehydrated quickly.

Continue breastfeeding unless the child’s healthcare professional gives different instructions. Formula-fed infants should generally continue their usual formula rather than switching products or diluting it without professional guidance.

Offer an oral rehydration solution in small, frequent amounts when recommended. A spoon or oral syringe may help, but never force fluid into the mouth or squirt it toward the back of the throat.

Contact the child’s healthcare professional promptly if the child:

• Is younger than 12 months and has significant vomiting or diarrhea
• Was born prematurely
• Has an ongoing medical condition
• Refuses fluids
• Cannot keep down small amounts
• Has fewer wet diapers
• Has a dry mouth or no tears
• Is unusually sleepy, weak, or irritable
• Has frequent watery stools
• Has blood or pus in the stool
• Has green vomit
• Has severe abdominal pain
• Has a fever, especially as a young infant
• Is not improving

Do not give a child an over-the-counter anti-diarrheal or anti-nausea medicine unless their healthcare professional specifically recommends it.

Vomiting and Diarrhea in Older Adults

Older adults may become dehydrated without experiencing strong thirst. They may also have less physical reserve and be more affected by medication changes, kidney problems, or electrolyte loss.

Watch for:

• New confusion
• Sudden weakness
• A fall
• Reduced urination
• Dizziness
• Difficulty standing
• Unusual sleepiness
• Refusal of fluids
• Changes in blood pressure or blood sugar
• Inability to take important medication

Contact a healthcare professional early when an older adult has repeated vomiting, frequent diarrhea, or a noticeable change from their usual condition.

What to Eat

Hydration is the first priority. Once vomiting has slowed and the person feels able to eat, begin with small portions.

Foods that may be easier to tolerate include:

• Toast
• Crackers
• Rice
• Oatmeal
• Bananas
• Applesauce
• Potatoes
• Soup
• Noodles
• Yogurt, when tolerated
• Eggs
• Plain chicken or other lean protein

There is usually no need to remain on an extremely limited diet for several days. Gradually return to a normal, balanced diet as appetite improves.

Avoid foods that clearly worsen symptoms. For a short time, this may include:

• Greasy or fried foods
• Very spicy foods
• Large meals
• Heavy or rich foods
• Large amounts of dairy if it increases diarrhea
• Alcohol
• Excessive caffeine
• Foods high in added sugar

Do not force food when the person is nauseated. Missing a few meals is generally less concerning than failing to replace fluids.

Rest and Move Carefully

Vomiting, diarrhea, and dehydration may cause weakness or dizziness.

Encourage the person to:

• Rest
• Stand up slowly
• Sit on the edge of the bed before walking
• Use support when going to the bathroom
• Keep a clear path to the bathroom
• Use nightlights
• Ask for help if they feel unsteady

Someone who is weak or lightheaded should not drive, shower alone, climb stairs unnecessarily, or walk without support.

Keep a Symptom Record

Write down:

• When symptoms began
• How often vomiting occurs
• How many loose stools occur
• Whether blood, pus, or unusual colors are present
• The person’s temperature
• Fluids consumed
• Urination
• Medications taken
• Abdominal pain
• Recent meals, travel, antibiotics, or sick contacts

This information can help a healthcare professional understand the severity and possible cause of the illness.

Over-the-Counter Anti-Diarrheal Medication

Some adults with uncomplicated diarrhea may be able to use an over-the-counter product such as loperamide or bismuth subsalicylate. These medicines are not appropriate in every situation.

Speak with a healthcare professional or pharmacist before using one if the person:

• Has bloody or black stool
• Has a high fever
• Has severe abdominal pain
• Recently took antibiotics
• Has inflammatory bowel disease
• Has liver or kidney disease
• Takes blood-thinning medication
• Is pregnant
• Is an older adult with other health conditions
• Is taking several medications
• Is a child or teenager

Slowing the intestines may be unsafe during certain bacterial or toxin-related infections. Do not take more than the label recommends or continue the medicine longer than directed.

Bismuth Subsalicylate Precautions

Bismuth subsalicylate contains a salicylate related to aspirin.

It may not be appropriate for:

• Children or teenagers recovering from a viral illness
• People allergic to aspirin
• People taking blood thinners
• People with bleeding disorders
• People with certain kidney conditions
• Pregnant people
• Anyone taking another salicylate-containing product

It can temporarily darken the tongue or stool. However, black, tarry stool can also be a sign of gastrointestinal bleeding. Do not assume a color change is harmless when there is weakness, dizziness, abdominal pain, vomiting blood, or uncertainty about the cause.

Ask a pharmacist or healthcare professional before using this medication.

Anti-Nausea Medication

Prescription anti-nausea medication may be helpful in some situations. Use it only as directed.

Some medications can cause:

• Drowsiness
• Dizziness
• Confusion
• Constipation
• Heart-rhythm problems
• Interactions with other medicines

Do not take medication prescribed to another person. Do not drive after taking a medicine that makes you sleepy or less alert.

If vomiting prevents you from keeping down prescription medication, contact the prescribing healthcare professional. Do not automatically repeat a dose that was vomited because some of it may already have been absorbed.

Do Not Use Leftover Antibiotics

Antibiotics do not treat viral stomach illnesses and are not appropriate for every bacterial infection. Using the wrong antibiotic can cause side effects, make diarrhea worse, and contribute to antibiotic resistance.

Some diarrheal illnesses require testing before treatment is selected. Do not use leftover medication or someone else’s prescription.

Contact a healthcare professional if symptoms began during or after antibiotic use. Certain infections associated with antibiotics can cause serious diarrhea and need specific treatment.

Blood in Vomit or Stool

Seek immediate medical care when:

• Vomit contains bright red blood.
• Vomit looks like coffee grounds.
• Stool contains a significant amount of red blood.
• Stool is black and tarry.
• Blood occurs with weakness, dizziness, fainting, or severe pain.

A small streak of blood after repeated forceful vomiting may result from irritation, but it still deserves professional medical advice.

Blood in the stool may result from several conditions, some of which require urgent treatment. Do not treat bloody diarrhea with an anti-diarrheal medicine unless a healthcare professional directs you to do so.

Unusual Vomit Colors

Seek prompt medical evaluation for vomit that:

• Is bright or dark green
• Contains blood
• Looks like coffee grounds
• Has a fecal appearance or odor
• Occurs with severe abdominal swelling
• Occurs with severe or focused abdominal pain

Green vomit can contain bile and may sometimes signal an intestinal blockage, particularly in infants and children.

Severe Abdominal Pain

Mild cramping can occur with a stomach illness. Severe, constant, sharply focused, or worsening pain is different.

Seek prompt medical attention when pain:

• Is severe
• Becomes focused in one area
• Occurs with a rigid or swollen abdomen
• Makes movement extremely painful
• Occurs with blood in vomit or stool
• Occurs during pregnancy
• Follows an injury
• Occurs with fainting or confusion
• Continues after vomiting or diarrhea improves

Do not assume every episode of vomiting and diarrhea is a stomach virus. Appendicitis, bowel obstruction, gallbladder disease, pancreatitis, medication reactions, poisoning, and other serious conditions can cause similar symptoms.

When Adults Should Contact a Doctor

Adults should seek prompt medical advice when:

• Vomiting is frequent or persistent.
• Diarrhea continues longer than approximately two days.
• There are six or more loose stools in one day.
• The person cannot drink enough to replace losses.
• Signs of dehydration develop.
• There is a high fever.
• Stool contains blood, pus, or is black and tarry.
• Vomit contains blood or looks like coffee grounds.
• Abdominal or rectal pain is severe.
• Symptoms improve and then return.
• The illness began during or after antibiotic treatment.
• The person recently traveled.
• Several people became ill after eating the same food.
• The person is pregnant, older, immunocompromised, or has another significant medical condition.

These warning signs are consistent with guidance from the National Institute of Diabetes and Digestive and Kidney Diseases. NIDDK: Symptoms of Viral Gastroenteritis

Medical Conditions That Require Extra Caution

Contact a healthcare professional sooner if the person has:

• Diabetes
• Kidney disease
• Heart failure
• A weakened immune system
• Inflammatory bowel disease
• A history of intestinal surgery
• An ostomy
• A bleeding disorder
• A serious chronic illness
• A prescribed fluid restriction
• A condition requiring medication that cannot be missed

Vomiting and diarrhea can change blood sugar, blood pressure, kidney function, and medication absorption.

A person with diabetes should follow their sick-day plan and monitor blood sugar or ketones as directed. Seek professional guidance if readings are abnormal or fluids cannot be kept down.

Preventing the Illness From Spreading

Vomiting and diarrhea are often contagious.

To reduce the spread:

• Wash hands thoroughly with soap and water.
• Wash after using the bathroom or changing a diaper.
• Wash before eating or preparing food.
• Do not share food, drinks, utensils, or towels.
• Clean frequently touched surfaces.
• Use separate bathroom facilities when possible.
• Keep the toilet lid closed before flushing when possible.
• Wash contaminated clothing and bedding promptly.
• Wear disposable gloves when cleaning vomit or stool.
• Keep a sick child home according to school or childcare rules.
• Follow workplace rules for returning after illness.

Hand sanitizer may be useful in some situations, but soap and water are especially important during suspected norovirus illness. The CDC states that hand sanitizer alone does not work well against norovirus. CDC: How to Prevent Norovirus

Cleaning Vomit or Diarrhea Safely

When cleaning:

1. Keep children and pets away from the area.
2. Open windows or improve ventilation when appropriate.
3. Wear disposable or rubber gloves.
4. Remove visible material with paper towels.
5. Place waste in a sealed plastic bag.
6. Clean and disinfect the entire affected area.
7. Use a product labeled as effective against the suspected germ, such as an EPA-registered product effective against norovirus.
8. Follow the product’s mixing, contact-time, ventilation, and surface instructions.
9. Wash contaminated laundry without shaking it.
10. Remove gloves and wash your hands with soap and water.

Never mix bleach with ammonia, vinegar, toilet-bowl cleaner, alcohol, or another cleaning product. Dangerous gases can result.

Do not use food-preparation utensils or reusable kitchen sponges to clean vomit or stool.

Food Preparation After Illness

A person with vomiting or diarrhea should not prepare or serve food for others.

For a suspected norovirus illness, CDC guidance recommends waiting at least 48 hours after symptoms stop before preparing food or caring closely for other people. Some workplaces, healthcare settings, schools, and food-service jobs may have stricter requirements.

Continue careful handwashing after recovery because some germs can remain in stool after symptoms improve.

Protecting the Skin

Frequent diarrhea can irritate the skin.

To reduce discomfort:

• Clean the area gently with warm water.
• Avoid aggressive wiping.
• Pat the skin dry.
• Use soft, unscented toilet tissue or wipes that are safe for the person.
• Apply a protective barrier ointment when appropriate.
• Change diapers or soiled clothing promptly.
• Wear breathable, loose-fitting clothing.

Contact a healthcare professional if the skin becomes severely painful, broken, infected, or develops a persistent rash.

Common Mistakes to Avoid

Try not to:

• Drink a large amount immediately after vomiting.
• Wait for severe thirst before replacing fluids.
• Give plain water alone in large quantities to a dehydrated infant.
• Dilute formula or oral rehydration solution incorrectly.
• Make an improvised rehydration mixture without reliable instructions.
• Force food when the person is nauseated.
• Give anti-diarrheal medicine to a child without professional guidance.
• Use anti-diarrheal medicine for bloody diarrhea or high fever without medical advice.
• Take leftover antibiotics.
• Repeat a vomited medication dose without asking a professional.
• Ignore black stool, blood, green vomit, or severe pain.
• Prepare food for others while sick.
• Rely only on hand sanitizer during a suspected norovirus outbreak.
• Mix cleaning chemicals.
• Allow a weak or dizzy person to walk without assistance.

A Simple Care Checklist

When someone has vomiting or diarrhea:

1. Check for emergency warning signs.
2. Begin small, frequent amounts of fluid.
3. Use an oral rehydration solution when appropriate.
4. Monitor urination and other signs of hydration.
5. Allow rest and prevent falls.
6. Introduce small amounts of food as tolerated.
7. Keep a record of symptoms, fluids, and medications.
8. Check with a professional before using anti-diarrheal or anti-nausea medication.
9. Contact a healthcare professional for persistent symptoms, frequent stools, high fever, blood, severe pain, or dehydration.
10. Wash hands with soap and water.
11. Clean contaminated surfaces and laundry safely.
12. Avoid preparing food or caring closely for others until it is safe to do so.

Most short-term stomach illnesses improve with time and careful hydration. The most important job is to keep watching the person—not only the number of times they vomit or use the bathroom—and respond quickly when dehydration or another serious warning sign appears.

Suggested Guides

• Managing a Fever Safely
• Preventing Dehydration & Recognizing the Warning Signs
• Using Over-the-Counter Medications Safely
• Choosing Between Your Doctor, Urgent Care & the Emergency Room
• First Aid Basics: What Everyone Should Know

Important Health & Safety Notice

The information in this guide is provided for general educational purposes only. Independence Answers is not a medical provider, and this content is not a substitute for professional medical advice, diagnosis, treatment, or supervision. Always follow the instructions of your doctor, pharmacist, or other qualified healthcare professional, especially if you have a medical condition, take medication, or are unsure whether an action is safe for you.

Do not ignore or delay seeking professional care because of something you read here. If you believe someone may be experiencing a serious or life-threatening emergency, call 911 or your local emergency number immediately.