The vomiting started before breakfast. You have been sick more times than you have counted, water comes straight back up, and it is now the middle of the afternoon. Someone else in the house had this last week and rode it out on the sofa with a bucket. You are on one of the weekly injections, and that is the part making you unsure whether riding it out is the same decision when you are the one doing it.
There are printed thresholds for this and they are measured in hours, so you can hold yourself against them from where you are sitting. Which one you have passed is the difference between waiting out another evening and picking up the phone.
Among the printed reasons to contact a provider right away, four are things you can time: vomiting for longer than 24 hours, being unable to keep any fluids down for 12 hours or more, not urinating for 8 or more hours, and having vomited 3 or more times in one day. Severe stomach pain is on the same list. Blood in the vomit, or dark material that looks like coffee grounds, is 911 rather than a call. Short of any of that, what is left to do is small amounts of clear liquid, often, and one eye on the clock.
Which marks on the clock turn waiting into calling
Three of the four are stretches of time on a clock and the fourth is a count. Passing any one of them is a reason to contact a provider right away: vomiting for longer than 24 hours, being unable to keep any fluids down for 12 hours or more, not urinating for 8 or more hours, or having vomited 3 or more times in one day. Severe stomach or belly pain is on that same list, and so are a headache or a stiff neck.
Notice where the clock starts on the second one. It runs from the last time something stayed down, not from the first time you were sick, and those are usually hours apart. If you cannot pin either, take the earlier of the two.
Two things belong to 911 rather than to a phone call: blood in the vomit, and dark, coffee-colored material in it. Vomiting you think came from poisoning stands on the same footing.
Dehydration has its own list of signs, and they run alongside those four rather than instead of them. Among the adult signs are feeling very thirsty, a dry mouth, urinating and sweating less than usual, dark-colored urine, dry skin, tiredness and dizziness. Confusion, fainting, no urination at all, a racing heart or rapid breathing move it from a call to help right away.
Why your clock is shorter than the rest of the household's
Your clock is shorter than theirs because the label for this kind of medicine prints a consequence for dehydration that nobody weighing an ordinary stomach bug is thinking about: reports of acute kidney injury, in some cases requiring dialysis. Most of the reported cases followed the same route you are on tonight: sickness, vomiting or diarrhea that led to dehydration. That is a description of the reports, not a prediction about you.
The printed follow-up is a check on kidney function for anyone reporting reactions that could drain fluid, picked out as mattering most while the medicine is new or has recently been changed. That check is a blood test somebody has to order, which is the practical reason the call is not a formality — it is what starts it.
The stomach adds to it. Slowing the stomach down is part of how these medicines work, so what you sip sits in the stomach longer than it would have a year ago. Keep sipping anyway: slower out of the stomach is not the same as lost, and small amounts often is still what the printed home-care advice says to do.
Whether the next injection goes ahead while this is happening belongs to whoever prescribes it, so ask them today rather than on the day it is due.
What to do while you are deciding
While you are deciding, take clear liquid in small amounts often rather than a glass at a time. Sports drinks and other drinks without caffeine or alcohol help with mild dehydration, and the oral rehydration fluids sold over the counter are the most useful of them.
Keep two times written down, because a clinician will ask for both and neither is easy to reconstruct afterward: when anything last stayed down, and when you last urinated. A note on your phone is enough, and it is what turns a vague answer into the one that decides what happens next.
If someone is in the house, tell them the two signs that mean 911 and the thresholds you are counting toward. A decision that has to be made after another six hours of this is better not resting on the person who has been vomiting all day.
Right now
- Write down the time anything last stayed down, and the time you last urinated.
- Sip clear liquid in small amounts, often — an over-the-counter oral rehydration fluid if you have one, or any drink without caffeine or alcohol.
- Call your clinician the moment you pass any of the four thresholds, or if the stomach pain turns severe.
- Call 911 for blood, or for dark coffee-colored material, in the vomit.
- Message whoever prescribes the injection today, and ask what they want done about the next one.
- Tell whoever is with you which signs you are watching for.
A bug going round the house and a reaction to the medicine look identical from a bathroom floor, and the thresholds above are timed rather than diagnostic for exactly that reason — they work while nobody yet knows which one you have. Where they stop working is on someone whose own history moves the line. If you have kidney or heart trouble, or take something of your own that a dry spell would affect, ask your clinician what your threshold is now, while you are well enough to have the conversation.
