What are the common causes of stomach flu with lower back pain. How can you differentiate between various conditions causing these symptoms. What are the effective treatments for stomach flu accompanied by lower back pain.

The Link Between Stomach Flu and Lower Back Pain

Stomach flu, medically known as gastroenteritis, is a common ailment that affects millions of people worldwide. While its primary symptoms typically involve the gastrointestinal tract, many individuals report experiencing lower back pain alongside their stomach discomfort. This combination of symptoms can be both puzzling and concerning for those affected.

The association between stomach flu and lower back pain is not always straightforward. In some cases, the back pain may be directly related to the viral infection causing the stomach flu. In others, it could be a secondary effect of dehydration or muscle strain from frequent vomiting or diarrhea. Understanding this connection is crucial for proper diagnosis and treatment.

Why does stomach flu sometimes cause lower back pain?

There are several reasons why stomach flu might lead to lower back pain:

• Dehydration: Excessive fluid loss from vomiting and diarrhea can lead to muscle cramps, including in the lower back.
• Muscle strain: The physical act of vomiting can put strain on the muscles in the abdomen and back.
• Inflammation: Some viruses that cause stomach flu can also trigger inflammation in other parts of the body, including the lower back.
• Referred pain: Discomfort in the abdominal organs can sometimes be felt in the back due to shared nerve pathways.

Common Causes of Stomach Flu with Lower Back Pain

While stomach flu is often viral in nature, the combination of gastrointestinal symptoms and lower back pain can be attributed to various conditions. Identifying the underlying cause is essential for appropriate treatment and management.

Viral Gastroenteritis

Viral gastroenteritis, commonly known as stomach flu, is a frequent cause of combined stomach and back pain. Norovirus and rotavirus are among the most common culprits. These viruses can cause inflammation throughout the digestive system, leading to abdominal discomfort that may radiate to the lower back.

Kidney Infection

A kidney infection, or pyelonephritis, can manifest with symptoms similar to stomach flu, including nausea, vomiting, and diarrhea. The infection often causes pain in the lower back or sides, where the kidneys are located. Kidney infections require prompt medical attention to prevent complications.

Appendicitis

Although appendicitis typically causes pain in the lower right abdomen, some people may experience referred pain in the lower back. This condition can also cause nausea, vomiting, and diarrhea, mimicking stomach flu symptoms. Appendicitis is a medical emergency requiring immediate intervention.

Differential Diagnosis: Distinguishing Between Conditions

Given the overlap in symptoms, it’s crucial to differentiate between various conditions that can cause stomach flu-like symptoms with lower back pain. Healthcare providers use a combination of patient history, physical examination, and diagnostic tests to make an accurate diagnosis.

How can you tell if lower back pain is related to stomach flu or another condition?

Consider the following factors:

• Timing of symptoms: In stomach flu, gastrointestinal symptoms typically precede back pain.
• Nature of pain: Stomach flu-related back pain is often dull and generalized, while conditions like kidney stones cause sharp, localized pain.
• Associated symptoms: Fever, chills, and body aches are more common in viral infections.
• Duration: Stomach flu usually resolves within a few days, while chronic conditions persist longer.

If symptoms are severe, persistent, or accompanied by high fever or bloody stools, seeking medical attention is crucial for proper diagnosis and treatment.

Treatment Approaches for Stomach Flu with Lower Back Pain

Managing stomach flu with lower back pain involves addressing both the gastrointestinal symptoms and the back discomfort. The approach to treatment depends on the underlying cause and severity of symptoms.

What are effective home remedies for stomach flu with lower back pain?

For mild cases of stomach flu with associated back pain, the following home remedies can provide relief:

1. Rest: Allow your body time to recover and fight off the infection.
2. Hydration: Drink plenty of clear fluids to replace lost electrolytes and prevent dehydration.
3. Gentle stretches: Perform light stretches to alleviate back muscle tension.
4. Heat therapy: Apply a heating pad to soothe lower back pain.
5. Bland diet: Consume easily digestible foods like bananas, rice, and toast once vomiting subsides.

Medical Interventions

In more severe cases or when home remedies are insufficient, medical interventions may be necessary. These can include:

• Antidiarrheal medications: To reduce the frequency of bowel movements and associated discomfort.
• Pain relievers: Over-the-counter or prescription medications to address back pain.
• Antiemetics: Medications to control nausea and vomiting.
• Intravenous fluids: In cases of severe dehydration.
• Antibiotics: If a bacterial infection is suspected or confirmed.

It’s important to consult a healthcare provider before taking any medications, especially if symptoms are severe or prolonged.

Preventing Stomach Flu and Associated Back Pain

While it’s not always possible to prevent stomach flu, certain measures can reduce the risk of infection and minimize the likelihood of developing associated back pain.

How can you reduce your risk of stomach flu and related back pain?

Consider implementing these preventive strategies:

• Practice good hygiene: Wash hands frequently with soap and water, especially before eating and after using the bathroom.
• Avoid contaminated food and water: Be cautious when traveling to areas with poor sanitation.
• Strengthen your immune system: Maintain a healthy diet, exercise regularly, and get adequate sleep.
• Stay hydrated: Drink plenty of water throughout the day to support overall health.
• Practice proper food handling: Cook foods thoroughly and avoid cross-contamination in the kitchen.

By following these preventive measures, you can reduce your risk of contracting stomach flu and experiencing associated back pain.

When to Seek Medical Attention

While many cases of stomach flu with lower back pain can be managed at home, certain symptoms warrant immediate medical attention. Recognizing these warning signs is crucial for preventing complications and ensuring proper treatment.

What symptoms indicate a need for urgent medical care?

Seek medical attention if you experience any of the following:

• Severe, persistent abdominal pain
• High fever (above 102°F or 39°C)
• Bloody stools or persistent vomiting
• Signs of severe dehydration (extreme thirst, dark urine, dizziness)
• Intense lower back pain that doesn’t improve with home remedies
• Difficulty urinating or pain during urination
• Symptoms lasting more than a few days without improvement

These symptoms may indicate a more serious condition requiring professional medical evaluation and treatment.

Long-term Management and Follow-up Care

For individuals who experience recurrent episodes of stomach flu with lower back pain, long-term management strategies and follow-up care are essential. These approaches can help prevent future occurrences and improve overall quality of life.

How can you manage recurring stomach flu and back pain episodes?

Consider the following long-term management strategies:

1. Identify triggers: Keep a symptom diary to recognize patterns or triggers that may lead to episodes.
2. Dietary modifications: Work with a nutritionist to develop a diet plan that minimizes gastrointestinal distress.
3. Stress management: Practice stress-reduction techniques like meditation or yoga to support overall health.
4. Regular exercise: Engage in low-impact exercises to strengthen core and back muscles.
5. Probiotics: Consider incorporating probiotic-rich foods or supplements to support gut health.

Regular follow-up appointments with your healthcare provider can help monitor your condition and adjust treatment plans as needed. They may recommend additional tests or specialist consultations if symptoms persist or worsen over time.

Understanding the Mind-Body Connection in Stomach Flu and Back Pain

The relationship between stomach flu, back pain, and mental health is an area of growing interest in medical research. Stress and anxiety can exacerbate gastrointestinal symptoms and contribute to muscle tension, potentially worsening back pain. Conversely, chronic gastrointestinal issues can lead to increased stress and anxiety, creating a cycle of discomfort.

How does stress impact stomach flu and back pain symptoms?

Stress can affect stomach flu and back pain in several ways:

• Weakened immune system: Chronic stress can suppress immune function, making you more susceptible to viral infections.
• Increased muscle tension: Stress often leads to muscle tightness, particularly in the back and abdomen.
• Altered gut motility: Stress can affect digestive processes, potentially exacerbating diarrhea or constipation.
• Heightened pain perception: Stress and anxiety can lower pain thresholds, making discomfort feel more intense.

Incorporating stress-reduction techniques into your daily routine can help manage both the physical and emotional aspects of stomach flu with lower back pain. Mindfulness meditation, deep breathing exercises, and cognitive-behavioral therapy are effective strategies for many individuals.

By addressing the mind-body connection, you can develop a more holistic approach to managing and preventing episodes of stomach flu with associated back pain. This comprehensive strategy can lead to improved overall health and well-being, reducing the frequency and severity of symptoms over time.

Lower Back Pain and Diarrhea: Causes and Treatment

Lower back pain and diarrhea can occur together for many reasons. IBS, constipation, enteropathic arthritis, and cancer are just some conditions that may cause both. You may need medical care if both persist.

Lower back pain and diarrhea are both very common symptoms. Approximately 80 percent of adults experience low back pain at some point, and diarrhea is one of those symptoms that can just creep up on anyone from time to time.

One study from 2014 of chiropractic patients found that the number of people with low back pain and bowel issues was high, even though there didn’t seem to be a specific cause or link between the two.

If you experience recurring lower back pain and diarrhea, it’s possible that you may have an underlying medical condition. We’ll explain some of those causes below.

Lower back pain and diarrhea that’s accompanied by fever, severe abdominal pain, or a loss of bladder or bowel control may indicate a serious medical condition, such as appendicitis or cauda equina syndrome. Call 911 or go to your nearest emergency department.

Your lower back pain and diarrhea may be completely unrelated, but if your symptoms are recurring, chances are that there’s an underlying medical cause.

Here are some possible causes for these symptoms:

Appendicitis

Appendicitis is the inflammation of the appendix, which is a small organ that extends from the first part of the colon in your lower right abdomen.

The pain from appendicitis usually begins near the navel and spreads to the lower right side of your abdomen. Some people have an appendix that extends behind the colon, which may cause lower back pain.

Other symptoms include:

• diarrhea or constipation
• fever
• loss of appetite
• abdominal pain that can become severe
• nausea and vomiting
• an inability to pass gas

Appendicitis needs immediate treatment. Left untreated, your condition can worsen dramatically in just a matter of hours, and your appendix can rupture.

A ruptured appendix can spread infection through your abdominal cavity and is life-threatening. See a doctor right away if you have symptoms of appendicitis.

Kidney infection

Also called infectious pyelonephritis, a kidney infection is a type of urinary tract infection (UTI) that often begins in the bladder or urethra and spreads upward to one or both kidneys.

A kidney infection can cause permanent damage to your kidneys or spread to your bloodstream when left untreated.

You should see a doctor right away if you experience sudden lower back pain and diarrhea, along with nausea and fever.

Pain in your side or pelvis is also possible, along with symptoms of a lower UTI with cystitis (urinary bladder inflammation). These other symptoms include:

• a burning sensation when urinating
• urgent or frequent urination
• cloudy or smelly urine

A kidney infection requires immediate treatment with antibiotics to reduce the risk of serious complications. It may require hospitalization.

Fecal impaction

Fecal impaction is when a large, hard dry stool stays stuck in the rectum. It’s most often caused by chronic constipation, which can be associated with the long-term use of certain laxatives.

When you’re constipated, your stool becomes dry and hard, making it difficult to pass. The risk increases if you stop taking laxatives after using them for a long time because your intestines forget how to move stool on their own.

Fecal impaction is more common in older people but can happen to people of any age who experience chronic constipation.

Fecal impaction can cause abdominal and lower back pain and pressure. You may also experience leakage of liquid from your rectum or sudden watery diarrhea after long-term constipation.

Other symptoms can include:

• cramping
• bloating
• rectal bleeding
• bladder pressure
• bladder incontinence

Irritable bowel syndrome (IBS)

IBS is a common chronic disorder that’s estimated to affect 10 to 15 percent of the world population.

It’s characterized by a collection of symptoms, such as:

• bloating
• abdominal pain
• diarrhea
• constipation

While IBS doesn’t lead to cancer or other serious diseases, and isn’t known to permanently damage the colon (the way inflammatory bowel diseases may), it can be very uncomfortable.

The symptoms of IBS can vary and can come and go. Along with abdominal pain, IBS can cause lower back pain and diarrhea, accompanied by nausea.

It can also cause constipation or a combination of diarrhea and constipation that may alternate with each other. Other common symptoms include:

• cramping
• excess gas
• mucus in the stool

Enteropathic arthritis

Enteropathic arthritis is a chronic, inflammatory arthritis that’s associated with inflammatory bowel disease (IBD).

Types of IBD include ulcerative colitis and Crohn’s disease, and roughly 1 in 5 people with either type will develop enteropathic arthritis.

Different types of arthritic diseases can cause similar symptoms or be associated with developing IBD, such as ankylosing spondylitis and psoriatic arthritis.

IBD usually causes diarrhea and abdominal pain. IBD that’s associated with arthritis of the spine can cause lower back pain and diarrhea.

Other symptoms vary depending on the type of IBD and arthritis, and may include:

• joint pain and stiffness
• bloody diarrhea
• cramping
• loss of appetite
• fatigue

Pancreatic cancer

Pancreatic cancer accounts for 3 percent of all cancers in the United States, according to the American Cancer Society.

The symptoms of pancreatic cancer vary depending on the type and location of the tumor, and the stage of the cancer. Early pancreatic cancers often don’t cause any signs or symptoms.

The following are possible signs and symptoms:

• upper abdominal pain
• back pain
• nausea
• dark urine
• jaundice
• weight loss
• poor appetite
• diarrhea
• nausea and vomiting

It’s important to remember that many of these symptoms are more often caused by other less serious conditions. If you’re concerned about pancreatic cancer, see a doctor.

See a doctor if your symptoms don’t improve after a few days.

Seek emergency care if you experience:

• severe abdominal or back pain
• high fever
• blood in your stools
• sudden loss of bowel or bladder control
• severe dizziness or confusion

Occasional lower back pain and diarrhea are fairly common symptoms that may be completely unrelated. Having them together may not indicate an underlying condition.

Any recurring or severe symptoms should be discussed with your doctor so they can rule out more serious causes.

Back Pain and Vomiting: Causes and Treatments

Back Pain and Vomiting: Causes and Treatments

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Medically reviewed by Alana Biggers, M. D., MPH — By Rachel Nall, MSN, CRNA — Updated on August 3, 2017

Overview

Back pain can vary in severity and type, from sharp and stabbing to dull and aching. Back pain is common because the back acts as a support and stabilizing system for the body, making it vulnerable to injury and strain.

Vomiting occurs when the contents of your stomach are forcefully ejected from your mouth. Food poisoning and viral infections are common causes of vomiting.

When you experience back pain with vomiting, it’s important to consider when your back pain started. For example, forceful vomiting could lead to back pain and strain. Common causes of vomiting include:

• food poisoning
• indigestion
• infections (usually related to bacterial and viral illnesses)
• motion sickness

Back pain and vomiting are also commonly associated with a urinary tract infection (UTI) or kidney infection. These conditions result when bacteria build up in the urinary tract, leading to infection. A kidney infection is the more serious of the two. Other symptoms of a kidney infection include blood in the urine, pain in the side of the torso, chills, and fever.

Morning sickness associated with pregnancy can cause nausea and vomiting. Back pain is also common with pregnancy, as the weight of the growing baby puts strain on the back. Often these symptoms are not a cause for concern for pregnant women. However, when nausea occurs after the first trimester, it may be a symptom of preeclampsia. Preeclampsia is a condition where blood pressure becomes too high. If you are pregnant and experience nausea into your second trimester, seek medical advice from your doctor.

Less common causes of back pain and vomiting include:

• bacterial meningitis
• Crohn’s disease
• endometriosis
• pancreatitis
• a spinal tumor
• uterine fibroids, noncancerous tumors in the uterus

Other causes of back pain and vomiting include:

• menstruation
• premenstrual syndrome (PMS)
• gallstones
• kidney stones
• ectopic pregnancy
• pelvic inflammatory disease (PID)
• typhus
• pancreatic cancer
• hyperparathyroidism
• porphyrias
• West Nile virus infection
• yellow fever
• polio
• heart attack
• abdominal aortic aneurysm

Most vomiting will subside within a day. If back pain is the result of vomiting, it should also subside after a few days of rest.

Seek immediate medical attention if you are pregnant and experiencing these symptoms unrelated to morning sickness. Call your doctor right away if you have the following symptoms in addition to back pain and vomiting:

• blood in your vomit or stool
• confusion
• extreme physical weakness
• a severe headache and stiff neck
• loss of control over bladder or bowel movements
• severe abdominal pain
• worsening symptoms

Also, call your doctor if your back pain continues after your vomiting subsides or if vomiting continues for 24 hours.

Although you can’t always prevent back pain and vomiting, you can take steps to avoid triggers. Common triggers include:

• drinking too much alcohol
• eating too much food
• eating foods that are undercooked
• excess stress
• poor hygiene when preparing food

Last medically reviewed on December 1, 2016

How we reviewed this article:

Healthline has strict sourcing guidelines and relies on peer-reviewed studies, academic research institutions, and medical associations. We avoid using tertiary references. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.

• Abdominal bloating: A mysterious symptom. (n.d.).
  med.unc.edu/ibs/files/educational-gi-handouts/Abdominal%20Bloating.pdf
• Gas in the digestive tract. (n.d.).
  digestive.niddk.nih.gov/ddiseases/pubs/gas/
• Mayo Clinic Staff. (2014). Kidney infection.
  mayoclinic.org/diseases-conditions/kidney-infection/basics/definition/con-20032448
• Mayo Clinic Staff. (2014). Morning sickness.  
  mayoclinic.org/diseases-conditions/morning-sickness/basics/definition/con-20033445
• Mayo Clinic Staff. (2015). Urinary tract infection.
  mayoclinic.org/diseases-conditions/urinary-tract-infection/basics/definition/con-20037892
• Mayo Clinic Staff. (2014). Viral gastroenteritis.
  mayoclinic.com/health/viral-gastroenteritis/DS00085

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Medically reviewed by Alana Biggers, M. D., MPH — By Rachel Nall, MSN, CRNA — Updated on August 3, 2017

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Can a cold or flu cause back pain?

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According to the World Health Organization, about 40 million people suffer from infectious diseases every year and 90% of this number falls on SARS and influenza. Vaccination does not guarantee protection against all types of viruses. You can catch the infection anywhere: in public transport, in a store, in any public place. In addition to the usual symptoms – fever, cough, runny nose – colds and flu often cause pain in the back, muscles and joints. Many try not to pay attention to the ailment and endure the disease “on their feet”, and this is fraught with serious complications, especially with the flu. It must be distinguished from the common cold in order to contact a specialist in time and avoid serious consequences.

Influenza:

• The onset of the disease is always acute, symptoms appear immediately
• Immediately develops high temperature up to 39 degrees
• Symptoms of body intoxication – chills, sweating, severe headache, nausea, photophobia, pain in muscles and joints
• Redness of the eyes
• Cough, runny nose and sneezing appear on the 2-3rd day of illness
• With influenza and within two weeks after recovery, the person is very weak, there is shortness of breath, loss of appetite, dizziness, heart palpitations

SARS:

• Symptoms develop and increase gradually over 1-2 days
• The temperature rises slightly, not higher than 38 degrees
• Runny nose, cough (first dry, then wet) are often the first manifestations of the disease
• Recovery usually occurs in 7-9 days
• Pain in muscles and joints is not severe, aching

Causes of back pain in influenza and SARS

In infectious diseases, back pain is quite common. It can be an obsessive aching, or a sharp shooting, localized in the neck, lower back, or between the shoulder blades. In any case, for adequate treatment, it is necessary to find out the cause of back pain:

• Intoxication. In infectious diseases, especially influenza, the virus literally destroys the cells of the body. And our immune system throws all its strength into the fight against the uninvited guest and releases a large amount of active substances that cause inflammation and raise the body temperature. All this poisons the body, and it responds with pain and aches in the muscles, back and joints, nausea, chills and migraines.
• Myositis. Inflammation of one or an entire muscle group may join the symptoms of the flu or a cold. The pain is clearly localized, aggravated by movement or pressure on the affected area, the skin over it is hot. Myositis of the neck is especially dangerous, because it can affect the muscles of the larynx and trachea, making breathing and swallowing difficult.
• Osteochondrosis. If the back muscles are weakened from age or a sedentary lifestyle, the intervertebral discs become depleted and deformed. With a cold and flu, the vessels that feed the muscles and ligaments around the spine suffer, and osteochondrosis can worsen. Pain, stiffness, numbness appear in the back.
• Sciatica. This is an inflammation of the roots of the spinal cord, more often the lumbar spine suffers. The pain starts in the lower back and spreads down the leg to the very foot. There may be numbness, coldness in the limbs, a feeling of “creeping goosebumps”. Movements are constrained and difficult. With radiculitis of the cervical spine, the back of the head, shoulder, shoulder blade, and sometimes the arm hurt. The pain increases sharply when turning the head, coughing, moving the hand.
• Spondylitis. This is an inflammation of the vertebrae. With colds and flu, immunity weakens. If there are constant sources of infection in the body (teeth not cured in time or chronic diseases of the throat), then pathogenic microorganisms with the blood stream can enter the spine and cause spondylitis or more severe purulent complications. The pain is aching, aggravated by movement, the affected area may become numb. It is difficult to bend your back, turn your head.
• Diseases of the kidneys. Weakening of immunity during colds and flu can cause inflammation of the kidneys or exacerbation of urolithiasis. If back pain is accompanied by swelling, high blood pressure and frequent urination, this is a reason to contact a nephrologist.

If you have already caught an infection, the best thing you can do for your body is to help it fight the virus and avoid complications. To do this, at the first sign of malaise, stay at home and observe bed rest.

For influenza and SARS, the general recommendations are similar:

• Drink plenty of warm water frequently: berry fruit drinks, water with lemon, weak tea. So toxins will leave the body faster and the manifestations of general intoxication will decrease, which means that the back will not hurt so much. Normally, after 3-4 days, the aches in the muscles and joints should go away. If the pain does not let go, but only grows, then the back hurts not due to intoxication and you need to contact a specialist as soon as possible.
• Do not self-medicate. Take any medications only after consulting a doctor.
• Don’t try to beat chills and back pain with a hot bath. So you will only overload the already hard-working heart and exacerbate inflammation in the muscles and ligaments of the back. Dry heat saves from chills – a woolen sweater, scarf or plaid.
• Pain in the back muscles is well relieved by ointments and gels with anti-inflammatory components. Apply Nise gel to the area of ​​soreness and lie down under the covers – relief will come quickly.
• Eat light, nutritious food in small portions – broth, boiled meat, eggs, cottage cheese.

* THERE ARE CONTRAINDICATIONS. READ THE INSTRUCTIONS FOR MEDICAL USE OR CONSULT A DOCTOR.

If after 5-7 days of bed rest the symptoms of a cold and flu do not go away, and pain and discomfort in the back increase, you should consult a doctor. The specialist will find out the cause of the pain and prescribe adequate treatment. This will help to avoid serious complications and recover as quickly as possible.

• http://med135.ru/node/215
• http://kb4-vlg.ru/poleznaya-informatsiya/orvi/
• https://www.starcrb.ru/index.php/novosti/179-orvi-i-gripp-etiologiya-patogenez-klinika-profilaktika-aktualnost-grippa-i-orvi
• https://medi.ru/info/12035/
• https://www.bsmu.by/page/6/5208/
• https://b-apteka.ru/articles/pnevmoniya-orvi-gripp
• https://www.infomed39.ru/for-citizens/helpful-info/guide-to-influenza/

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Volgograd residents complain of severe back pain

org/Person”> Photo: Alexander Oshchepkov

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Dangerous viruses continue to rage in Volgograd, including SARS and influenza. According to doctors, many patients come to them with a frightening symptom – lower back pain. What are these pains and what is their cause, said Mikhail Statsenko, head of the Department of Internal Medicine at Volgograd Medical University.

Residents of Volgograd, who had been ill more than once or twice over the past autumn, said that, in addition to fever, cough and runny nose, severe back pain joined the extremely unpleasant and painful symptoms of the disease.

— Throughout my illness, my lower back ached, it felt like my body had been passed through a meat grinder, — said those who had recovered from Volgograd. “I didn’t know what to think—either it was the kidneys, or the lungs were already so tired from coughing that they began to hurt.

According to Mikhail Statsenko, there can be several reasons for back pain.

“It’s intoxication,” the doctor said. – Pain in the muscles, joints, body aches – all this indicates intoxication of the body. You need to see if you’ve taken a lot of fever medication. The same “Ibuprofen”, it is nephrotoxic, it has a negative effect on the kidneys, “Paracetamol” negatively affects the liver, but it lowers the temperature. Each person has his own weak point, and you need to take drugs based on your own observations and feelings.

As Mikhail Statsenko said, it is very important to start treatment on time and competently, not missing the moment when complications appear. Moreover, weakened immunity becomes an easy target for other viruses and even bacteria.

— Drink more fluids. At a high temperature, you still need to take the same antipyretic drugs, the doctor said. – But it is better to alternate drugs. In this way, we distribute the load on the organs and reduce the toxic effect on them. You need to pay attention to your condition. Drama appears only when the fever persists for more than five days, when complications appear in the form of sinusitis, bronchitis and pneumonia.