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When Is the Flu Not the Flu?
By Sterling Warren, RN, MS, CEN  
Emergency Department Director, Texas Health Huguley Hospital Fort Worth South



When is the flu not the flu?  When it’s the “stomach flu.” 

Emergency departments across the region are busy in the winter months helping patients who suffer from the fever, congestion, muscle aches and fatigue of influenza.  Lately, we’ve been seeing fewer cases of influenza and more cases of “stomach flu,” which is not really the flu.  It actually refers to gastroenteritis or irritation and inflammation of the stomach and intestines. 

Nearly everyone has experienced the symptoms of gastroenteritis:  abdominal cramps, stomach pain, nausea, vomiting and diarrhea.  Depending on the cause, sometimes fever, headache and swollen lymph glands are also present. 

Stacy, who is 23, was enjoying spring break with her family until a headache and severe nausea began.  Within two hours, she began vomiting every 15 minutes.  Two hours later, she also began having diarrhea.  Her family realized that her body was losing fluids quickly and brought her to the emergency department, where she received four liters of intravenous fluids and medication to reduce her nausea and diarrhea. 
Stacy’s condition improved, but then the gastroenteritis hit the other family members.  However, their vomiting was not as frequent or prolonged, so no emergency care was necessary.

When should you go to the emergency department with gastroenteritis?
The most immediate concern with gastroenteritis is dehydration, which can be avoided by continuing to drink small amounts of fluid frequently.  In the case of Stacy, her stomach could not tolerate even a tiny amount of liquid. Go to the emergency department if:
• You think vomiting is from poisoning
• You notice blood or dark, coffee-colored material in the vomit
• You have symptoms of dehydration:  sunken eyes, light-headedness, dry or sticky mucous membranes in the mouth, lack of normal elasticity of the skin, decreased urine output or decreased tears
• Small children should be evaluated for dehydration if they have vomited more than three times in an hour.

It may not be an emergency, but call a health care provider or seek medical care if you have:
• Been vomiting for longer than 24 hours or four or more times per day.
• Been unable to keep any fluids down for 12 hours or more
• Headache or stiff neck
• Not urinated for 8 or more hours
• Severe stomach or belly pain

When you are able to keep food down, bland foods, like toast, rice, bananas, and applesauce, should be tried first.  Avoid high protein or high fat foods for 24 hours. 

Kids and Gastroenteritis
With their smaller bodies, children can become dehydrated more quickly, especially if they are experiencing vomiting and diarrhea at the same time.   Children can also spike a high fever rapidly.  If they are too young to talk, the first sign of gastroenteritis may be that they won’t eat or drink and their activity level is down.

What Causes a Stomach Flu?
Gastroenteritis can be caused by bacteria, viruses, parasites, food allergies, and poor hygiene.   Stomach viruses are notorious for spreading rapidly because of poor hand washing.  In fact, many doctors call stomach flu "a family affair" because it is so highly contagious and often goes through all members of a family, as it did in Stacy’s case.  Several cruise ships have made headlines in recent months when hundreds of passengers came down with gastroenteritis.

To help keep it from spreading, wash hands frequently.  Keep children with gastroenteritis out of day care or school until all symptoms are gone.

When is the “stomach flu” like the flu?  For both, fluids and rest will help you recover, as they both can leave you feeling tired and weak.  In Stacy’s case, it took four days to feel like herself again.