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What Causes Upper Abdominal Pain, Chills, Vomiting And Diarrhea?
Question: General details of patient
Gender:Female
Age: 68
Height: 145cm (4'9")
Weight: 35 Kg
Race/region: South Asian, South XXXXXXX
Blood pressure: 110/70
Blood sugar: 80mg/dL
No previous history of hypertension or diabetes
Complaint started on 19 Nov 2015 - Day 1
Specific complaint:
Center upper abdomen pain that is sometimes pulsating since 8AM on Day1
Vomiting (4 times) and diarrhea (5 times) till 8PM on Day 1. No liquid or solid food
Day 2: No vomiting or diarrhea. Occasional chills followed by sweating. No liquid or solid food.
Day3: Enema done by local nurse as directed by doctor. Occasional chills with fever followed by sweating and no fever. Gelusil 20 ml. Milk of magnesia 20ml. No Solid food. Buttermilk 50ml.
Day 4: Enema done by local nurse as directed by doctor. Occasional chills followed by sweating. Gelusil 20 ml. Milk of magnesia 20ml. No Solid food. Buttermilk 50ml
Cifran CT 500mg at 9PM as prescribed directed by local doctor
Diarrhea during chills and fever during midnight (once)
Day 5: No fever or chills. Buttermilk 50ml, orange -1 banana -1/2 Cifran CT 500mg at 9AM and again at 9PM.
Day 6 (today): Abdomen pain persists. Feeling full after consuming 10-15ml of any liquid or 25 grams of any solid. Weakness and unable to move from bed.
Please suggest some medicine as medical facilities like scanning centers are far away and the patient is in a delicate condition to endure the journey.
and for 90 hours now. Any solid food is immediately vomited. Liquids up to 20 milliliters are allowed at a time with 30 minute intervals. What medicine do you suggest?
Gender:Female
Age: 68
Height: 145cm (4'9")
Weight: 35 Kg
Race/region: South Asian, South XXXXXXX
Blood pressure: 110/70
Blood sugar: 80mg/dL
No previous history of hypertension or diabetes
Complaint started on 19 Nov 2015 - Day 1
Specific complaint:
Center upper abdomen pain that is sometimes pulsating since 8AM on Day1
Vomiting (4 times) and diarrhea (5 times) till 8PM on Day 1. No liquid or solid food
Day 2: No vomiting or diarrhea. Occasional chills followed by sweating. No liquid or solid food.
Day3: Enema done by local nurse as directed by doctor. Occasional chills with fever followed by sweating and no fever. Gelusil 20 ml. Milk of magnesia 20ml. No Solid food. Buttermilk 50ml.
Day 4: Enema done by local nurse as directed by doctor. Occasional chills followed by sweating. Gelusil 20 ml. Milk of magnesia 20ml. No Solid food. Buttermilk 50ml
Cifran CT 500mg at 9PM as prescribed directed by local doctor
Diarrhea during chills and fever during midnight (once)
Day 5: No fever or chills. Buttermilk 50ml, orange -1 banana -1/2 Cifran CT 500mg at 9AM and again at 9PM.
Day 6 (today): Abdomen pain persists. Feeling full after consuming 10-15ml of any liquid or 25 grams of any solid. Weakness and unable to move from bed.
Please suggest some medicine as medical facilities like scanning centers are far away and the patient is in a delicate condition to endure the journey.
and for 90 hours now. Any solid food is immediately vomited. Liquids up to 20 milliliters are allowed at a time with 30 minute intervals. What medicine do you suggest?
Brief Answer:
Oral antiobiotics are probably needed
Detailed Answer:
Hello, Sir/Madam.
I can certainly understand your concerns.
I apologize for the delayed response owing to my work schedule.
I have worked through your query in detail.
This seems to be a clear cut case of Acute infectious Gastroenteritis.
This in the majority of cases needs therapy with oral antibiotics.
As of now stop Magnesium salts.Replenish with oral liquids with an Electrobion electrolyte solution twice a day.
I generally recommended my patients with oral pills of Orni O for 5 days.
Intensive work up is needed only if she does not respond well to antibiotic therapy.
Please check with your physician if he shares my view and if can prescribe these medications for her.
Post your further queries if any.
Thank you.
Oral antiobiotics are probably needed
Detailed Answer:
Hello, Sir/Madam.
I can certainly understand your concerns.
I apologize for the delayed response owing to my work schedule.
I have worked through your query in detail.
This seems to be a clear cut case of Acute infectious Gastroenteritis.
This in the majority of cases needs therapy with oral antibiotics.
As of now stop Magnesium salts.Replenish with oral liquids with an Electrobion electrolyte solution twice a day.
I generally recommended my patients with oral pills of Orni O for 5 days.
Intensive work up is needed only if she does not respond well to antibiotic therapy.
Please check with your physician if he shares my view and if can prescribe these medications for her.
Post your further queries if any.
Thank you.
Above answer was peer-reviewed by :
Dr. Prasad
Hello Dr. XXXXXXX Heijebu,
Thank you very much for the detailed answer. I can understand the pressure of daily work on time availability.
Orni O 500mg 2 times a day at 9AM and 9PM. This helped in curing her upper abdomen pain.
Ingestion of Magnesium salts was stopped after reading your reply. I tried giving her electrobion dissolved in water but she gets an aversion followed by nausea with it. She is able to ingest buttermilk with salt and the juice of one large size orange in a day and about 500 ml of water.
The complaints that she has now are
1) Intense lower abdomen pain on trying to ingest any semisolid food even in quantities of 25-50grams.
2) Constant lower abdomen pain.
3) Occasional mild fever (that is being addressed with crocin)
4) Constant dryness of mouth and lips irrespective of fever
5) Constant burning sensation in soles and palms irrespective of fever (applying moisturizer provides evanescent relief)
6)Constant drowsiness
7) Weakness and inability to move from bed.
Day wise progress since the previous mail
Day 6 : Upper abdomen pain abated a few hours after ingestion of Orni O 500mg.Constant lower abdomen pain, dryness of mouth and lips, burning sensation in soles and palms as listed above
Day 7 : A bit active. She could sit in a chair and read for about 7 hours (intermittently) in the day. (may be after being bedridden for 6 days). 2 doses of Orni O 500mg at 9AM and 9PM. Constant lower abdomen pain, dryness of mouth and lips, burning sensation in soles and palms as listed above.
Day 8 (today): Constant drowsiness. Tried to sit in a chair for about 1 hour but could not open eyes or read. The other aspects are detailed above.
Please suggest the next course of action. How to revive her?
Thank you very much for the detailed answer. I can understand the pressure of daily work on time availability.
Orni O 500mg 2 times a day at 9AM and 9PM. This helped in curing her upper abdomen pain.
Ingestion of Magnesium salts was stopped after reading your reply. I tried giving her electrobion dissolved in water but she gets an aversion followed by nausea with it. She is able to ingest buttermilk with salt and the juice of one large size orange in a day and about 500 ml of water.
The complaints that she has now are
1) Intense lower abdomen pain on trying to ingest any semisolid food even in quantities of 25-50grams.
2) Constant lower abdomen pain.
3) Occasional mild fever (that is being addressed with crocin)
4) Constant dryness of mouth and lips irrespective of fever
5) Constant burning sensation in soles and palms irrespective of fever (applying moisturizer provides evanescent relief)
6)Constant drowsiness
7) Weakness and inability to move from bed.
Day wise progress since the previous mail
Day 6 : Upper abdomen pain abated a few hours after ingestion of Orni O 500mg.Constant lower abdomen pain, dryness of mouth and lips, burning sensation in soles and palms as listed above
Day 7 : A bit active. She could sit in a chair and read for about 7 hours (intermittently) in the day. (may be after being bedridden for 6 days). 2 doses of Orni O 500mg at 9AM and 9PM. Constant lower abdomen pain, dryness of mouth and lips, burning sensation in soles and palms as listed above.
Day 8 (today): Constant drowsiness. Tried to sit in a chair for about 1 hour but could not open eyes or read. The other aspects are detailed above.
Please suggest the next course of action. How to revive her?
Brief Answer:
Correct dehydration.
Detailed Answer:
Hello, Sir.
I apologize for the delayed response owing to my work schedule.
I have gone through your query in detail.
Oral antibiotics have to be continued without fail for another 5days.
She probably seems to have Gross electrolyte imbalance which is causing all the mentioned symptoms.
Electrobion has to be given without fail. Try to use an orange flavoured pack to reduce nausea.Mix the contents in a glass/ 200 ml of Buttermilk/water/diluted fruit juice.This is the most important step.Low body sodium can cause drowsiness and low body potassium can cause generalised weakness.
The total water intake should be around 2-3 liters per day along with plenty of fruit juices(preferably orange , pineapple,apple and lot of coconut water). 500 ml is just not enough.
Give her MINUTE MAID PULPY ORANGE fruit drink 200 ml/day.
Dryness of lips, weakness, drowsiness, burning sensation of extremities are related directly to
dehydration.
Nausea needs a treatment with Oral pills of PANTOP D once daily at 7 am on empty stomach.I often prescribe this medication to my patients.Please check with your physician if he shares my view and if can prescribe these drugs to her.
If possible, try to get a complete electrolyte check along with arterial blood gas analysis.This helps in guiding us through.
Meanwhile keep her under strict observation , watch for urine out-put(given her vitals, it should be around 700-800 ml a day and not less than that) and her general alertness- if still no improvement within another 24 hrs , then Sir you just need to take her to your nearest ER without any further delay for intravenous fluid and electrolyte replacement.
Post your further queries if any.
Thank you.
Correct dehydration.
Detailed Answer:
Hello, Sir.
I apologize for the delayed response owing to my work schedule.
I have gone through your query in detail.
Oral antibiotics have to be continued without fail for another 5days.
She probably seems to have Gross electrolyte imbalance which is causing all the mentioned symptoms.
Electrobion has to be given without fail. Try to use an orange flavoured pack to reduce nausea.Mix the contents in a glass/ 200 ml of Buttermilk/water/diluted fruit juice.This is the most important step.Low body sodium can cause drowsiness and low body potassium can cause generalised weakness.
The total water intake should be around 2-3 liters per day along with plenty of fruit juices(preferably orange , pineapple,apple and lot of coconut water). 500 ml is just not enough.
Give her MINUTE MAID PULPY ORANGE fruit drink 200 ml/day.
Dryness of lips, weakness, drowsiness, burning sensation of extremities are related directly to
dehydration.
Nausea needs a treatment with Oral pills of PANTOP D once daily at 7 am on empty stomach.I often prescribe this medication to my patients.Please check with your physician if he shares my view and if can prescribe these drugs to her.
If possible, try to get a complete electrolyte check along with arterial blood gas analysis.This helps in guiding us through.
Meanwhile keep her under strict observation , watch for urine out-put(given her vitals, it should be around 700-800 ml a day and not less than that) and her general alertness- if still no improvement within another 24 hrs , then Sir you just need to take her to your nearest ER without any further delay for intravenous fluid and electrolyte replacement.
Post your further queries if any.
Thank you.
Above answer was peer-reviewed by :
Dr. Arnab Banerjee
Hello Dr. XXXXXXX Heijebu,
Thank you very much for the detailed reply. Your reply helped me convince her that the root cause of all the issues is dehydration. I am trying my best to give her all the fluids you mentioned in your reply. Most of her complaints have been addressed to a great extent. She is also able to have some 100 grams of wheat porridge (semi solid) twice daily. She complains of heaviness and pain in lower abdomen after drinking any liquid and prefers sitting posture over lying down all the time as she finds sitting relatively less painful for the lower abdomen when compared to lying down
She had painful shingles on upper left torso, in September 2014. Postherpetic Neuralgia along with weakness of her hip joint leading to inability to get up or sit in a chair seem to be the main causes for her reluctance to recover and she considers this gastroentritis as a blessing in disguise. She has thanked you very much and is very happy to know that you too are an alumni of Andhra University.
Yours truly,
XXXX
P.S: Thank you once again for the great and sincere help her. Albeit it pains me a lot (as her only progeny) to see her choose this option, I am trying my best to convince her for a quick recovery. I have no answer to her question, "Why should I recover for a painful life?"
Thank you very much for the detailed reply. Your reply helped me convince her that the root cause of all the issues is dehydration. I am trying my best to give her all the fluids you mentioned in your reply. Most of her complaints have been addressed to a great extent. She is also able to have some 100 grams of wheat porridge (semi solid) twice daily. She complains of heaviness and pain in lower abdomen after drinking any liquid and prefers sitting posture over lying down all the time as she finds sitting relatively less painful for the lower abdomen when compared to lying down
She had painful shingles on upper left torso, in September 2014. Postherpetic Neuralgia along with weakness of her hip joint leading to inability to get up or sit in a chair seem to be the main causes for her reluctance to recover and she considers this gastroentritis as a blessing in disguise. She has thanked you very much and is very happy to know that you too are an alumni of Andhra University.
Yours truly,
XXXX
P.S: Thank you once again for the great and sincere help her. Albeit it pains me a lot (as her only progeny) to see her choose this option, I am trying my best to convince her for a quick recovery. I have no answer to her question, "Why should I recover for a painful life?"
Brief Answer:
Additional antibiotic is a need now
Detailed Answer:
Hello, Madam.
I can certainly understand your concerns.
I apologize for the delayed response owing to my work schedule.
Thank you so much for your appreciation.
Maintain adequate hydration as earlier advised.This is the most vital step.
At this point, I would like to add Oral pill of additional antibiotic AUGMENTIN CA for 5 days.Likewise ORNI-O can be continued for another 3 days.
Hip weakness can be related to padt episodes of Herpes Zoster. This is isn't a major issue at the moment.
Please check with your physician if he shares my view and if can prescribe these medications to you.
If possible, make all arrangements together for an ultrasound abdomen.
Post your further queries if any.
Thank you.
Additional antibiotic is a need now
Detailed Answer:
Hello, Madam.
I can certainly understand your concerns.
I apologize for the delayed response owing to my work schedule.
Thank you so much for your appreciation.
Maintain adequate hydration as earlier advised.This is the most vital step.
At this point, I would like to add Oral pill of additional antibiotic AUGMENTIN CA for 5 days.Likewise ORNI-O can be continued for another 3 days.
Hip weakness can be related to padt episodes of Herpes Zoster. This is isn't a major issue at the moment.
Please check with your physician if he shares my view and if can prescribe these medications to you.
If possible, make all arrangements together for an ultrasound abdomen.
Post your further queries if any.
Thank you.
Note: For further follow up on digestive issues share your reports here and Click here.
Above answer was peer-reviewed by :
Dr. Chakravarthy Mazumdar
Answered by
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