What causes shivers and vomiting. How are chills related to nausea. Why do some people experience shaking rigors. When should you seek medical attention for chills and vomiting.

The Connection Between Chills and Vomiting

Chills and vomiting often occur together as symptoms of various medical conditions. Understanding the relationship between these two symptoms can help identify the underlying cause and determine appropriate treatment.

Chills are the body’s natural response to feeling cold or fighting an infection. They involve involuntary muscle contractions that generate heat. Vomiting, on the other hand, is the forceful expulsion of stomach contents through the mouth. When these symptoms occur simultaneously, it may indicate a more serious condition.

Common Causes of Chills and Vomiting

• Viral infections (e.g., influenza, gastroenteritis)
• Bacterial infections
• Food poisoning
• Severe allergic reactions
• Certain medications
• Pregnancy (morning sickness)

Is there a link between the severity of chills and the likelihood of vomiting. While not always directly correlated, more severe chills can sometimes indicate a more intense immune response, which may increase the chances of experiencing nausea and vomiting.

Decoding Shaking Chills (Rigors)

Shaking chills, also known as rigors, are intense episodes of shivering accompanied by a sudden rise in body temperature. These violent muscle contractions are the body’s attempt to rapidly increase its core temperature, often in response to an infection.

Characteristics of Rigors

• Sudden onset of severe shivering
• Teeth chattering
• Difficulty controlling body movements
• Rapid heart rate
• Sweating (as body temperature rises)

Do rigors always indicate a serious condition. While rigors can be alarming, they don’t always signify a severe illness. However, they often suggest the presence of an infection and should be evaluated by a healthcare professional, especially if accompanied by other symptoms like vomiting.

Gastroenteritis: A Common Culprit

Gastroenteritis, commonly known as stomach flu, is a frequent cause of both chills and vomiting. This inflammation of the gastrointestinal tract is typically caused by viral infections, although bacteria and parasites can also be responsible.

Key Symptoms of Gastroenteritis

1. Nausea and vomiting
2. Diarrhea
3. Abdominal cramps
4. Fever and chills
5. Headache
6. Muscle aches

Can gastroenteritis cause severe dehydration. Yes, the combination of vomiting, diarrhea, and fever can lead to significant fluid loss, potentially resulting in dehydration. This is particularly dangerous for young children and older adults.

Influenza: When Chills and Vomiting Signal the Flu

Influenza, or the flu, is a respiratory illness that can cause a wide range of symptoms, including chills and vomiting. While not everyone with the flu experiences gastrointestinal symptoms, they are more common in children.

Distinguishing Flu Symptoms

• Sudden onset of symptoms
• High fever (usually above 101°F or 38.3°C)
• Severe body aches
• Extreme fatigue
• Dry cough
• Chills and sweats
• Occasional nausea and vomiting

How long do flu symptoms typically last. Most people recover from the flu within one to two weeks. However, some individuals, especially those in high-risk groups, may develop complications that prolong the illness.

The Role of Fever in Chills and Vomiting

Fever often accompanies chills and can sometimes lead to vomiting, especially in children. As the body’s temperature rises, it can trigger various physiological responses, including nausea and increased muscle tension.

Understanding Fever

• Normal body temperature: 97.7°F to 99.5°F (36.5°C to 37.5°C)
• Fever threshold: Generally considered 100.4°F (38°C) or higher
• High-grade fever: 103°F (39.4°C) or higher

Why does fever sometimes cause vomiting. The elevated body temperature can affect the digestive system, slowing gastric emptying and potentially leading to nausea and vomiting. Additionally, the immune response that causes fever can also trigger the release of chemicals that may induce nausea.

When to Seek Medical Attention

While many cases of chills and vomiting can be managed at home, certain situations warrant immediate medical attention. Recognizing these signs can help prevent serious complications.

Red Flags for Immediate Care

• Severe, persistent vomiting
• Inability to keep fluids down for 24 hours
• Signs of dehydration (dark urine, dry mouth, dizziness)
• High fever not responding to over-the-counter medications
• Severe abdominal pain
• Vomiting blood or coffee ground-like material
• Chest pain or difficulty breathing
• Severe headache with neck stiffness

How can you differentiate between a mild illness and a more serious condition. Pay attention to the duration and severity of symptoms, as well as any accompanying signs like persistent high fever, severe pain, or changes in mental status. When in doubt, consult a healthcare professional.

Treatment Approaches for Chills and Vomiting

The treatment for chills and vomiting depends on the underlying cause. However, there are general strategies that can help manage symptoms and promote recovery.

Home Remedies and Self-Care

1. Rest and hydration
2. Gradual reintroduction of bland foods (BRAT diet)
3. Over-the-counter pain relievers and fever reducers
4. Cool compresses for fever
5. Avoidance of triggering foods and substances

Medical Interventions

• Antiviral medications (for influenza)
• Antibiotics (for bacterial infections)
• Antiemetic drugs (to control nausea and vomiting)
• Intravenous fluids (for severe dehydration)
• Hospitalization (in severe cases)

Can probiotics help with gastrointestinal symptoms. Some studies suggest that certain probiotic strains may help reduce the duration and severity of diarrhea associated with gastroenteritis. However, more research is needed to establish their effectiveness in managing other symptoms like vomiting.

Prevention Strategies for Chills and Vomiting

While it’s not always possible to prevent chills and vomiting, certain measures can reduce the risk of contracting illnesses that cause these symptoms.

Effective Prevention Techniques

• Regular hand washing
• Proper food handling and storage
• Vaccination (e.g., annual flu shot)
• Avoiding close contact with sick individuals
• Maintaining a healthy lifestyle (balanced diet, regular exercise, adequate sleep)
• Stress management

How effective are hand sanitizers in preventing the spread of viruses. While hand sanitizers can be effective against many bacteria and viruses, they are not as effective as proper handwashing with soap and water, especially when hands are visibly dirty or after using the bathroom.

Understanding the connection between chills and vomiting can help individuals recognize potential health issues and seek appropriate care. While many cases resolve on their own with proper self-care, it’s crucial to be aware of warning signs that may indicate a more serious condition. By maintaining good hygiene practices and a healthy lifestyle, one can reduce the risk of experiencing these uncomfortable symptoms. Remember, when in doubt about the severity of your symptoms, it’s always best to consult with a healthcare professional for personalized advice and treatment.

14 Reasons You Have Chills

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Body chills may mean you have a fever but there are other causes.

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Written by

Petrina Craine, MD.

Assistant Clinical Professor of Emergency Medicine, Columbia University

Last updated July 19, 2023

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Written by

Petrina Craine, MD.

Assistant Clinical Professor of Emergency Medicine, Columbia University

Last updated July 19, 2023

Chills quiz

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11 most common causes

Hypothyroidism

Acute URI

Urinary Tract Infection

Menopause

Strep Throat

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Sinusitis

Anemia

Pneumonia

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Viral Gastroenteritis

Coronavirus

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Why are you having chills?

Chills can be uncomfortable. You may be wrapped in the heaviest down blanket, but still unable to get warm. You may feel cold and clammy, or you may be sweating with a fever and feeling overheated.

Chills, or shivering, can happen one time or they can be frequent. They can last a few seconds or as long as an hour. Sometimes chills can cause noticeable shaking movements; other times visible symptoms are minimal—you may just feel chilled to the bone.

Chills are your body’s attempt to raise your internal body temperature if you’re cold or sick. When your muscles involuntarily contract and relax, it generates heat. If you’re sick, chills can create more heat to help kill a virus or bacteria.

Chills can also be caused by menopause, low blood sugar levels, or when you’re experiencing profound emotions like shock, fear, or anxiety.

Extreme exertion—such as running a marathon—can also cause chills as your body tries to regulate temperature to avoid overheating.

Causes

1. Gastroenteritis (stomach flu)

Symptoms

• Nausea or vomiting
• Stomach pain
• Diarrhea
• Chills or fever

Gastroenteritis, or stomach flu, is inflammation of your gastrointestinal organs, like your stomach and intestines. It is usually caused by infection with a virus, such as the rotavirus or norovirus. Most people recover on their own in a few days without any specific medical treatment beyond caring for themselves at home.

It is very important to stay hydrated as the body can lose a lot of water and electrolytes from throwing up or diarrhea. If you think you’re dehydrated or cannot keep any foods or liquids down, talk to your doctor. Your doctor may recommend hospitalization for monitoring and IV fluids for rehydration.

Also, gastroenteritis can sometimes mimic other more serious conditions such as appendicitis, which often has symptoms like fever, nausea and vomiting, and belly pain. Call your doctor when in doubt about the cause of your symptoms.

2. Influenza (flu)

Symptoms

• Fever
• Cough
• Congestion
• Chills
• Headache
• Body aches
• Nausea, vomiting, diarrhea (especially in young children)

The flu is an infection of the respiratory tract (your lungs, nose, and mouth) caused by the influenza virus. There are different types of flu viruses. The reason you need to get a flu shot every year is because the version it protects against changes.

Most people who get the flu recover in a few days. Sometimes, it develops into pneumonia, which can be life-threatening, especially for the elderly or people with compromised immune systems.

If you are at risk of severe flu symptoms, see your doctor right away or go to urgent care. They may prescribe an antiviral medication. It can reduce how many days you are sick and the risk of complications.

Treating the flu is about taking care of your symptoms. You can take over-the-counter pain relievers like acetaminophen or ibuprofen. Get plenty of rest and drink lots of fluids.

It’s important to see a doctor if symptoms don’t get better or your fever lasts for more than 3 to 5 days.

Pro Tip

Sometimes patients tell me that they feel “silly” about bringing up questions about their chills. We are always here to help patients and hear their concerns. You mentioning your chills could be a vital step in first alerting us that something may be wrong with your health. —Dr. Petrina Craine

3. Pneumonia

Symptoms

• Fever
• Chills
• Cough (which may also produce mucus/phlegm)
• Trouble breathing or increased breathing rate
• Fatigue
• Chest pain
• Nausea, vomiting, loss of appetite, and diarrhea (especially in younger children)
• Confusion (especially in the elderly)

Pneumonia is an infection in your lungs that is usually caused by viruses and bacteria. The infection irritates the air sacs, filling them with pus and other fluids. Colds, bronchitis, influenza, and other respiratory infections can become pneumonia as bacteria settles into your lungs.

Pneumonia can be life-threatening, especially to the elderly or people with compromised immune systems.

Pneumonia is often diagnosed with a chest x-ray. Pneumonia caused by bacteria can be treated with antibiotics and many people can continue taking the medication as they recover at home.

You may have to be admitted to the hospital if you have low oxygen levels, severe dehydration, or other complications.

4. COVID-19

Symptoms

• Fever
• Loss of taste or smell
• Cough or congestion, which may produce mucus
• Runny nose
• Nausea, vomiting, or diarrhea
• Chest pain
• Fatigue
• Body aches
• Chills
• Headache
• Low oxygen levels on a pulse oximeter (oxygen measuring device)

COVID-19 is a highly contagious virus caused by a coronavirus, specifically the SARS-CoV-19. This virus infects the respiratory tract (including your nose, throat, sinuses, and lungs). Although it is a respiratory infection, it can also affect other organs including the brain, blood vessels, and the skin.

Symptoms are very similar to those seen in the flu and the common cold. Sometimes, cases of COVID-19 that begin with mild symptoms worsen and become life-threatening. COVID-19 is very contagious, even when people don’t have symptoms.

Rest and hydration can be important in treating symptoms and feeling better for people with mild cases of COVID-19. If you suspect COVID-19, monitor your symptoms and speak with your doctor about your condition.

They will give you additional at-home treatment plans. These may include over-the-counter medication, oxygen-monitoring devices, or prescription medication, like an inhaler. They can also advise you when to go to the hospital if your symptoms get worse.

5. Sinusitis

Symptoms

• Fever
• Runny nose
• Congestion
• Chills
• Facial pain or pressure
• Headache
• Cough that may produce mucus
• Foul-smelling breath or taste in mouth

The sinuses normally produce thin mucus to help trap foreign materials. When infected with viruses or bacteria, this fluid often increases and gets thicker—causing blockages. The infection affects the small air pockets in your forehead, nose, cheekbones, and in between your eyes. This is called sinusitis. Most sinus infections are caused by viruses, so antibiotics won’t help treat symptoms. If your symptoms last longer than 10 days or get worse after 5 to 7 days, you may have a bacterial infection. Your doctor may prescribe antibiotics. 

Over-the-counter decongestants (such as pseudoephedrine) should be used with care. Taking beyond 3 days may lead to an increased risk of the congestion coming back. It can sometimes be even worse than before. Watch your symptoms. Hydrate (liquids like water and tea) to help relieve pressure.

6. Strep throat

Symptoms

• Fever
• Sore throat
• Painful swallowing
• Tender lymph nodes
• Swollen, red tonsils
• Chills

Strep throat is a throat infection caused by a bacteria called group A Streptococcus. Strep throat is contagious and more common in children than adults. A main symptom is a very sore throat that can make eating, talking, or swallowing difficult. Sometimes, you get strep throat with a rash that looks like sandpaper—this rash is known as scarlet fever.

Strep throat is diagnosed with a test. It is treated with antibiotics. If not treated, strep can turn into a more serious illness such as rheumatic fever. Antibiotics may make you feel better within a few days, but you must take the antibiotics for the full amount prescribed.

Dr. Rx

Not all chills are necessarily negative. Some happen after deeply positive emotions, like after experiencing inspiring or moving music. This reaction is called “frisson.” —Dr. Craine

7. Urinary tract infection (UTI)

Symptoms

• Painful urination
• Increased urge or frequency of urination
• Pain in pelvic or rectal area
• Back pain
• Fever and chills (more so for an upper UTI)
• Nausea or vomiting
• Confusion (especially in elderly)

A urinary tract infection is an infection of your urinary tract that can affect the bladder, the urethra (the tube you urinate through), or the kidneys, which filter urine. This infection is commonly caused by bacteria but can also be caused by other germs like fungi. Pregnant women are prone to UTIs.

Most people who experience chills from a UTI have an upper urinary tract infection. This is a sign that your kidneys and ureters (inner tube that passes urine from the kidneys to the bladder) are infected.

A UTI is diagnosed with a urine sample and can be treated with antibiotics. If not treated, a UTI can become very serious and infect your kidneys (pyelonephritis) and your bloodstream.

8. Common cold

Symptoms

• Runny nose
• Cough and congestion
• Low fever
• Chills and body aches (usually mild)
• Fatigue

A common cold is a viral infection of the respiratory tract (usually just your nose and mouth). Many types of viruses can cause it, but rhinoviruses are a common culprit.

Most people with the cold do not have severe symptoms and get better without complications. Over-the-counter medications, such as decongestants (such as pseudoepinephrine) and natural foods like honey (in ages 2 and older), may relieve symptoms like congestion, cough, and sore throat. Resting and staying hydrated can also help you feel better.

9. Medication side effect

Symptoms

• Chills
• Recently taking or changing medications

Recovering from anesthesia after a surgery can sometimes cause chills. This is from anesthetics affecting body temperature regulation, the cool temperature of operating rooms, and your body cooling down while under anesthesia.

Abruptly stopping certain medications or substances, such as benzodiazepines, alcohol (in a person who drinks large amounts of it daily), or opioids like heroin or oxycodone (in a person dependent on them) can cause chills.

Let your doctor know if you’re experiencing chills as a reaction to a new medication or if you’re withdrawing from a medication or substance.

10. Hypothyroidism

Symptoms

• Unexplained weight gain
• Dry, cool skin
• Chills
• Constipation
• Leg and face swelling
• Decreased appetite
• Recently taking or changing medications

Hypothyroidism is a condition in which your thyroid is underactive. Thyroid hormones are involved in various body processes, a key one being metabolism. Low thyroid hormone levels increase your sensitivity to temperature changes and make you more likely to feel chilled.

Hypothyroidism can be caused by various conditions such as your immune system attacking your thyroid or a nutritional deficiency in iodine (an important mineral for thyroid hormone production).

Diagnosis is made with a blood test. Medications can be used to manage hypothyroidism.

11. Cancer

Symptoms

• Fever that comes and goes
• Unexplained weight loss
• Easily bruised skin
• Swollen lymph nodes
• Chills
• Fatigue

Cancer can be associated with a persistent low-grade fever, as well as chills. This is especially true for certain blood cancers like leukemia, lymphoma, or myeloma.

See your doctor If a fever doesn’t break or you have a continual low-grade fever or a low-grade fever that seems to come and go. You may also notice other symptoms, such as unexplained weight loss, swollen lymph glands, or fatigue. Blood cancers may also cause symptoms that include easily bruised skin or bleeding gums.

Tests can be used to diagnose cancer. Treatment depends on the type of cancer and how far it has progressed. Treatment may include chemotherapy, radiation, and/or surgery.

12. Autoimmune disease

Symptoms:

• Fatigue
• Swollen glands
• Joint pain
• Chills
• Digestive issues
• Skin or hair changes

Chills are often a symptom of various autoimmune diseases such as lupus and rheumatoid arthritis. Of those suffering from an autoimmune disease, nearly 80% are women. The reasons for this are not entirely clear, but hormonal changes (e.g. with estrogen and progesterone) and variations in sex chromosomes are thought to contribute to the large amount of women over men with autoimmune disorders.

Autoimmune disorders can have a range of symptoms and can be complicated to diagnose. Often, diagnosis is made by ruling out other causes. Treatment can include symptom management, medication, and immunotherapy.

13. Menopause

Symptoms:

• Hot flashes
• Chills
• Fatigue
• Mood changes
• Unexplained weight changes
• Decreased libido
• Headaches

Menopause is a period in a woman’s life in which her menstrual cycle ceases. It usually occurs between the ages of 45 and 55. Women experience significant changes in hormones, which can affect their body’s temperature regulation. It typically can cause “hot flashes,” but it can also cause chills. Chills can occur after a woman is “cooling down” after a hot flash or in place of hot flashes, a phenomenon known as  “cold flashes.”

Your doctor may recommend blood tests to test hormone levels. Treatment can include symptom management with medications, including hormone-replacement therapy.

14. Anemia

Symptoms

• Fatigue
• Headache
• Feeling cold or chills
• Lightheadedness or dizziness
• Palpitations (irregular, rapid, or particularly strong  heartbeat)
• Chest pain
• Shortness of breath

Anemia occurs when your body doesn’t have enough red blood cells to carry oxygen to your tissues. This affects nearly every process in the body, including temperature regulation. There are different causes of anemia, including problems with iron (e.g., losing blood from colon cancer or heavy menstrual cycles). Anemia is more common in women than men, and can be a particular problem for pregnant women due to increased nutritional needs during pregnancy.

A doctor may recommend iron supplements.

Pro Tip

Sometimes patients look for goosebumps—when the hair on your body sticks up on skin—when they feel chills. They are not the same. Goosebumps can happen with chills, like if you are outside in the cold or if you are having a strong emotional reaction. But they are not always present with chills, such as chills with fever. —Dr. Craine

Other possible causes

A number of conditions may also cause chills, though these are either rare or chills are not the defining symptom. These include extreme sunburn (rare), malaria, and tuberculosis.

When to call the doctor

• Chills persist even when you don’t have a fever.
• You have a cough, cold, or sore throat you can’t seem to shake.
• You experience body aches even when you haven’t exercised or exerted yourself.
• You have night sweats.
• You have a low-grade fever that doesn’t resolve, or seems to come and go.
• You notice hair or skin changes like your hair falling out.
• You’ve had unexplained weight loss.
• You experience fatigue regardless of how much you’ve slept.
• You experience constipation or diarrhea despite dietary changes.

Should I go to the ER for chills?

You should go to the emergency department if you have any of these signs:

• Rapid or irregular heartbeat that persists
• Skin color changes such as turning red, white, or black
• Shortness of breath
• Chest pain
• Fever (usually 102°F and greater)
• Confusion or hallucinations
• Dizziness or fainting
• Seizures

Those with weakened immune systems (e.g., elderly adults, babies, people with cancer, people on medications that suppress the immune system, people with chronic conditions like diabetes, kidney failure, etc. ) should visit an emergency room as chills could be a sign of a severe infection brewing.

Treatment

At-home care

• Medications to help reduce fever  such as acetaminophen (Tylenol) and non-steroidal anti-inflammatory drugs (Advil, Motrin)
• Drink lots of fluids
• Warming up if you’ve been outside in cold temperatures

Other treatments you might have

• Medical testing to help identify the cause of chills
• IV hydration
• Hospital monitoring
• Medication review to ID any medications or interactions that may cause chills as a side effect
• Prescription medication or additional treatments to treat the underlying cause of chills

Petrina Craine, MD.

Assistant Clinical Professor of Emergency Medicine, Columbia University

Dr. Petrina Craine is an emergency medicine physician who hails from Memphis, TN. After graduating as valedictorian of her high school, she moved to Durham, NC to pursue a degree in Biology and a certificate in Global Health. After college, she returned to her birthplace to attend the University of Tennessee Health Science Center College of Medicine. She successfully completed her medical degree a…

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Fever: What’s Causing It?

When fever spikes, it’s always a sign that something isn’t right. Likely reasons include that you’re fighting off a virus, flu or other infection, but there are also other possibilities. Here, how to treat fever at home and when to get medical attention.

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Abdominal Pain: Causes & When to Be Concerned

Abdominal pain is usually a sign of a common illness or infection. Other causes include indigestion, a stomach ulcer, IBS, or food poisoning.

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Caught the Common Cold? How to Treat & Prevent Its Spread

The common cold is a frequent and regular viral infection of the nose and throat. Conditions are usually harmless and symptoms resolve within two weeks.

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Flu (Influenza): Symptoms and How Long It Lasts

Influenza, or the flu, is a respiratory illness caused by a virus. It causes muscle aches, headache, fever, sore throat and makes you feel tired. Most people recover on their own.

Read more

Fever: What’s Causing It?

When fever spikes, it’s always a sign that something isn’t right. Likely reasons include that you’re fighting off a virus, flu or other infection, but there are also other possibilities. Here, how to treat fever at home and when to get medical attention.

Read more

Abdominal Pain: Causes & When to Be Concerned

Abdominal pain is usually a sign of a common illness or infection. Other causes include indigestion, a stomach ulcer, IBS, or food poisoning.

Read more

Caught the Common Cold? How to Treat & Prevent Its Spread

The common cold is a frequent and regular viral infection of the nose and throat. Conditions are usually harmless and symptoms resolve within two weeks.

Read more

Flu (Influenza): Symptoms and How Long It Lasts

Influenza, or the flu, is a respiratory illness caused by a virus. It causes muscle aches, headache, fever, sore throat and makes you feel tired. Most people recover on their own.

Read more

Fever: What’s Causing It?

When fever spikes, it’s always a sign that something isn’t right. Likely reasons include that you’re fighting off a virus, flu or other infection, but there are also other possibilities. Here, how to treat fever at home and when to get medical attention.

Read more

Abdominal Pain: Causes & When to Be Concerned

Abdominal pain is usually a sign of a common illness or infection. Other causes include indigestion, a stomach ulcer, IBS, or food poisoning.

Read more

Caught the Common Cold? How to Treat & Prevent Its Spread

The common cold is a frequent and regular viral infection of the nose and throat. Conditions are usually harmless and symptoms resolve within two weeks.

Read more

Flu (Influenza): Symptoms and How Long It Lasts

Influenza, or the flu, is a respiratory illness caused by a virus. It causes muscle aches, headache, fever, sore throat and makes you feel tired. Most people recover on their own.

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Norovirus (vomiting bug) – NHS

Norovirus, also called the “winter vomiting bug”, is a stomach bug that causes vomiting and diarrhoea. It can be very unpleasant, but usually goes away in about 2 days.

Check if you have norovirus

The main symptoms of norovirus are:

• feeling sick (nausea)
• diarrhoea
• being sick (vomiting)

You may also have:

• a high temperature
• a headache
• aching arms and legs

The symptoms start suddenly within 1 to 2 days of being infected.

How to treat norovirus yourself

You can usually treat yourself or your child at home.

The most important thing is to rest and have lots of fluids to avoid dehydration.

You will usually start to feel better in 2 to 3 days.

Find out how to treat diarrhoea and vomiting in children and adults

Important:
School, nursery or work

Stay off school or work until you have not been sick or had diarrhoea for at least 2 days. This is when you’re most infectious.

Do not visit hospitals or care homes during this time.

How norovirus is spread

Norovirus can spread very easily.

You can catch norovirus from:

• close contact with someone with norovirus
• touching surfaces or objects that have the virus on them, then touching your mouth
• eating food that’s been prepared or handled by someone with norovirus

Washing your hands frequently with soap and water is the best way to stop it spreading. Alcohol hand gels do not kill norovirus.

Urgent advice: Get advice from 111 now if:

• you’re worried about a baby under 12 months
• your child stops breast or bottle feeding while they’re ill
• a child under 5 years has signs of dehydration – such as fewer wet nappies
• you or your child (over 5 years) still have signs of dehydration after using oral rehydration sachets
• you or your child keep being sick and cannot keep fluid down
• you or your child have bloody diarrhoea or bleeding from the bottom
• you or your child have diarrhoea for more than 7 days or vomiting for more than 2 days

111 will tell you what to do. They can arrange a phone call from a nurse or doctor if you need one.

Go to 111.nhs.uk or call 111.

Other ways to get help

A GP may be able to help you.

Ask a GP surgery for an urgent appointment.

Check with the GP surgery before going in. A GP may speak to you on the phone.

Immediate action required: Call 999 or go to A&E if you or your child:

• vomit blood or have vomit that looks like ground coffee
• have green vomit (adults)
• have yellow-green or green vomit (children)
• might have swallowed something poisonous
• have a stiff neck and pain when looking at bright lights
• have a sudden, severe headache or stomach ache

What we mean by severe pain

Severe pain:

• always there and so bad it’s hard to think or talk
• you cannot sleep
• it’s very hard to move, get out of bed, go to the bathroom, wash or dress

Moderate pain:

• always there
• makes it hard to concentrate or sleep
• you can manage to get up, wash or dress

Mild pain:

• comes and goes
• is annoying but does not stop you doing daily activities

Page last reviewed: 17 June 2021
Next review due: 17 June 2024

Hypertensive crisis.

First Aid Methods.

Hypertensive crisis is a dangerous complication of hypertension requiring emergency care. Every person suffering from hypertension should remember that a hypertensive crisis can occur at almost any time. Therefore, not only all hypertensive patients, but also their relatives should know how to provide first aid with a sharp increase in blood pressure. A hypertensive crisis is a significant, sudden increase in blood pressure with neurovascular and humoral disorders. The occurrence of hypertensive crises is facilitated by acute neuropsychic overstrain, excessive alcohol consumption, sudden changes in the weather, the abolition of antihypertensive drugs, etc.

Allocate hypertensive crisis of I and II types and complicated.

Type I hypertensive crisis develops rapidly, there is a sharp headache, dizziness, nausea, flashing before the eyes, vomiting may occur. Patients are agitated, feel a feeling of heat, trembling throughout the body. Red spots appear on the skin of the neck, face, and sometimes the chest. The skin is moist to the touch. There may be an increased heartbeat and a feeling of heaviness behind the sternum. Tachycardia is noted. Arterial pressure is increased, mainly systolic (up to 200 mm Hg and above). Quite often crisis comes to an end with a plentiful urination.

Type II hypertensive crisis often develops in patients with stage II-III hypertension with insufficiently effective treatment or violation of the lifestyle. Crisis symptoms develop more slowly, but very intensively. Within a few hours, the headache increases. Nausea, vomiting, lethargy appear, vision and hearing deteriorate. The pulse is tense, but not rapid; Arterial pressure is sharply increased, mainly diastolic (up to 140-160 mm Hg).

Complicated hypertensive crisis can proceed according to the cerebral, coronary or asthmatic variant. In contrast to an uncomplicated hypertensive crisis, in complicated variants of a crisis against the background of high blood pressure, acute coronary insufficiency, acute left ventricular failure (cardiac asthma, pulmonary edema), acute cerebrovascular accident (hypertensive encephalopathy, transient cerebrovascular accident or stroke) can develop.

With the development of a hypertensive crisis, especially complicated, it is necessary to call an ambulance.

First aid for a hypertensive crisis consists in the immediate adoption of the following set of measures.

Provide the patient with a state of complete rest. It is contraindicated for him to walk and show any physical activity, you need to put him in a comfortable half-sitting position with the help of pillows. If the attack occurred on the street, you need to put folded clothes and other improvised means under his back. The head should always be above the level of the body to prevent increased blood flow and reduce the load on the vessels of the brain.

Reduce the brightness of lighting near the patient and, if possible, ensure maximum silence and the absence of external stimuli. People around should behave calmly and not panic, as nervousness is instantly transmitted to the patient.

Since the crisis makes breathing difficult, it is necessary to unbutton tight clothing, loosen the collar, scarf, tie, etc. If the patient is indoors, then it is necessary to provide him with an influx of fresh air, but it is important to ensure that he does not catch a cold.

The victim’s legs should be well warmed: apply a heating pad, a plastic bottle with hot water to them, you can put mustard plasters on the calf muscles.

Ask the patient if he suffers from high blood pressure, what medicines the doctor has prescribed for him to lower it, and give him this medicine. If the pressure does not decrease within an hour, the drug should be repeated, but care must be taken not to reduce the pressure too much – this can provoke loss of consciousness and further complicate the patient’s condition, especially in the elderly.

If it is not possible to give the patient his usual medicine, or if he has not previously taken antihypertensive drugs, he can be given a Nifedipine 10 mg tablet (but only if he does not have severe tachycardia and angina pectoris). The drug effectively reduces pressure. In the presence of heart disease or information about the patient’s intolerance to nifedipine, the drug can be replaced with captopril 12.5-25 mg, it normalizes blood pressure, protects the heart and prevents the development of nephropathy. In addition, unlike nifedipine, captopril does not cause drowsiness, dizziness and tachycardia. With a hypertensive crisis of the first type, it is advisable to use 40 mg of anaprilin orally or under the tongue in crushed form. In hypertensive crisis of the second type, diuretics are used, for example, furosemide 20-40 mg.

It is advisable to give the patient 40 drops of Corvalol to relieve anxiety, panic and fear of death, which usually cover a person in a state of hypertensive crisis. Instead of corvalol, valocordin, tincture of valerian or motherwort is suitable.

For heart pain, give the patient validol or nitroglycerin, but the latter must be used very carefully: it dilates blood vessels and can provoke collapse.

If possible, organize monitoring of blood pressure, record readings of the tonometer, pulse rate and respiration every 15-20 minutes until the doctor arrives.

Some patients mistakenly believe that a rapid decrease in blood pressure to the usual numbers will help to quickly get rid of the symptoms that accompany a hypertensive crisis. In no case should the pressure be sharply reduced, this can lead to a collapse, accompanied by loss of consciousness. In severe cases, this can lead to the development of ischemic changes in the brain and other organs as a result of blood flow depletion.

Health care workers manage a hypertensive crisis following medical protocol. It describes the standard of care for each specific disease. Patients with a non-stopping or complicated hypertensive crisis, as well as patients with an uncomplicated, but first-time hypertensive crisis, should be hospitalized in a cardiology or therapeutic department after providing them with emergency medical care.

Acute complications of diabetes mellitus

In diabetes mellitus, any type of diabetes, the most common acute complications are hypoglycemia (hypoglycemic coma) and ketoacidotic coma or condition.

Hypoglycemia (hypoglycemic coma)

Hypoglycemia (decrease in blood glucose less than 3 mmol / l) develops quickly, sometimes almost suddenly. Characterized by the following symptoms:

• Increased sweating
• Severe weakness, and comes on abruptly
• Trembling in the body
• Palpitations
• Hunger

It is worth noting that not all of these symptoms can be present together. There may also be some “own” sensations that the patient notes for himself throughout the illness. For example, tingling and numbness in the nose, tongue, or upper lip. Sometimes, hypoglycemia may not immediately show any symptoms, especially in patients with long-term ongoing diabetes, and this is dangerous. If hypoglycemia is not stopped, then hypoglycemic coma may develop, when the patient cannot independently take the necessary actions to treat hypoglycemia. So, hypoglycemia needs to be removed as quickly as possible and it needs to be done correctly. To quickly increase blood sugar, you need to take fast-digesting carbohydrates: 4-5 pieces of sugar, honey, jam, sweet fruit drinks or lemonade in an amount of 200 ml. Important Rule : A person with diabetes who is being treated with antidiabetic drugs should carry easily digestible carbohydrates with them at all times. It should be noted that in such situations, the most convenient is lump sugar or juice, lemonade. Honey – it is inconvenient to dose, it is difficult to carry with you, sweets are difficult to chew (caramel), or they may contain substances that slow down the absorption of carbohydrates (chocolate, soy candy).

In severe hypoglycemia (numbness with the impossibility of independent adequate actions or complete loss of consciousness – hypoglycemic coma), the patient cannot help himself. If consciousness is still preserved, you need to drink or feed sweets (see above). In case of coma, call an ambulance.

Recurrent hypoglycemia requires a mandatory visit to a doctor.

Ketoacidotic coma or condition

This condition, on the contrary, occurs with elevated sugar. This is an acute complication of the disease, caused by an absolute or pronounced relative deficiency of insulin due to inadequate insulin therapy or an increase in its demand. Factors that provoke the development of ketoacidotic coma:

• Insufficient dose or missed insulin injection (or tablet intake of antidiabetic agents)
• Unauthorized withdrawal of hypoglycemic therapy
• Mishandling of insulin administration
• Accession of other diseases (infections, injuries, operations, pregnancy, myocardial infarction, stroke, stress, etc.)
• Alcohol abuse
• Taking certain medications – glucocorticosteroids, etc.

Ketoacidotic state and later coma develops gradually, from several hours to several days. Worried about dry mouth, thirst, frequent urination, indicating an increase in decompensation of diabetes.