Upset stomach appears when viruses, parasites or bacteria damage the cells in the mucous membrane in the intestine. Normally, this membrane absorbs fluids, but when it is damaged it can no longer do it as effectively. The body therefore loses fluid through vomiting and diarrhoea.

Diarrhoea causes loss of fluids and salts. Children are more vulnerable to loss of fluids than adults; as they are smaller, they become dehydrated more quickly. Vomiting may lead to difficulties retaining the fluids consumed. Smaller children may deteriorate if they lose more fluids than they take in. This is why it is important that they drink from the onset of the stomach infection.

Vomiting and diarrhoea are the most common symptoms of upset stomach caused by a virus in children. The illness almost always cures itself and disappears in a couple of days. It is very important for children to drink fluids, especially if they have diarrhoea, which is particularly relevant in children under one year.

Symptoms

When children are suffering from upset stomach they may present different symptoms, including: vomiting, diarrhoea, discomfort, tummy ache, fever, tiredness and loss of appetite.

The symptoms normally appear all of a sudden, a couple of days after being infected, and disappear after a few days. Diarrhoea may last up to a week. Upset stomach is more common in winter, when children spend longer indoors. Although it may also be caused by bacteria, parasites or viruses, eating food that has gone off or travelling abroad.

When should I seek medical assistance?

You should go to your doctor or call 061 CatSalut Respon (Catalan Health Service care line) in the following cases:

• If the child is younger than six months and is vomiting or has diarrhoea
• There is no improvement after 24 hours
• Watery stools continue to appear two weeks after the upset stomach
• The child has a chronic illness
• If the child is vomiting or not retaining fluid and also has heavy diarrhoea, as the risk of dehydration is serious. The smaller the child, the more vulnerable they are.

You should seek urgent medical assistance if the child has diarrhoea, vomiting and any of these symptoms:

• unable to drink and urinating more than normal
• tired, does not want to play and shows no interest in their surroundings
• upset stomach that does not stop or gets worse
• blood in vomit or faeces

What can I do?

Children need fluids. They need to drink often. They can drink a bit at a time, in small quantities given to them with a spoon or bottle. Offer them water occasionally. It is important that they drink a bit at time, as if they drink too much in one go they may start vomiting again.

Avoid sweet drinks such as fizzy drinks or strong juices. They should also avoid diet drinks, as although they do not contain sugar, they may contain other products that cause diarrhoea. Infants may drink what they like, the most important thing is that they drink fluids.

If the child does not want to drink, try giving them ice lollies. You still need to offer them fluids. Even if they are eating ice lollies, they need to drink fluids to rehydrate themselves.

If the child is breast or bottle feeding, they should keep doing so, only more often, even if they vomit. If they do not want to breastfeed, you can also extract milk and feed them from a spoon.

A special syringe for medication is a good solution for oral rehydration. Make sure the liquid does not land directly on their palate, as this may cause nausea.

If vomiting is continuous, the child needs to drink two spoonfuls of liquid every five minutes, which is the equivalent of about 10 ml. An infant needs approximately 1 litre of liquid every 24 hours.

Sometimes an oral solution will need to be given

Oral solutions contain the amounts of salts and sugars required to help restore the body’s water balance. When children vomit often and have serious diarrhoea, it is a good idea for them to drink oral rehydration solutions. The infant may not want to drink the solution. If that is the case, try adding sugar.

You can find these solutions in pharmacies.

When vomiting stops, but diarrhoea continues

In most cases, it may be that the child stops vomiting but the diarrhoea continues for a while. Breastfeeding babies can continue feeding and babies drinking from a bottle can eat different types of preparations: rice, corn, formula milk, etc. depending on their age. You can find these preparations in pharmacies. You should start with small quantities.

If the child is older than six months, they may eat carrot soup.

When they are ready to start eating, it is better for them to eat normal foods. It is better to start with small quantities of food and avoid fruits and foods that have a fibre content.

If the child starts vomiting again

If the child starts vomiting again and is more tired than usual, does not have enough energy to play or loses their interest in their surroundings, see a paediatrician.

Can upset stomach be prevented?

Often, upset stomach is caused by a viral infection that is highly contagious. It is normal for people in the same family to be ill at the same time.

To prevent it from being passed on:

• Wash your hands with soap before meals and after going to the toilet
• Use your own towel
• Keep the bathroom dry and clean
• Put dirty nappies in plastic bags before throwing them in the rubbish
• Clean the changing table and wash your hands after changing the baby’s nappy

It is advisable for the child not to go back to nursery or school until two days after the symptoms disappear.

Drinking is essential to avoid dehydration

Every time the child passes diarrhoea or vomits they lose fluids and they need to replace them orally (by drinking). To achieve this, electrolyte solutions can be used. 

If the child is vomiting, they will need to drink the solution bit by bit (one teaspoon every 5 minutes). If they are not vomiting, increase the amount gradually. 

When they are not vomiting, offer them small amounts of food. Never force them to eat and make sure they drink plenty of fluids between meals.

How to prepare fluid solutions to treat diarrhoea

Low sodium oral electrolyte solution

• Dissolve the contents of the sachet in 1 litre of water (it does not need to be bottled water)
• Drink at room temperature and do not drink if it has been prepared for more than 24 hours. If they need more, make up some more.

Oral rehydration salts (ORS)

• Dissolve the contents of the sachet in 250 ml of tepid water and stir until dissolved.
• It can only be taken for 24 hours. If they need more, make up some more.

Rice water

• Add a small cup of rice to a litre of boiling water. Boil for approximately half an hour.
• Take off the heat, sieve the rice and, once cooled, put the water in the fridge.
• It can only be taken for 24 hours. If they need more, make up some more.

Homemade oral rehydration solution

• Add a teaspoon of salt and two teaspoons of sugar to 250 ml of water and stir until it dissolves.
• You can add a few drops of lemon juice
• It can only be taken for 24 hours. If they need more, make up some more.

Food

The child should not be fasting. Offer them food without forcing them to eat. Infants with gastroenteritis normally lose some of their appetite. If they are breastfeeding, the number of feeds should be increased. Milk bottles should continue to be given in the normal doses, they should not be diluted. 

A dry diet is not necessary, soft foods can be eaten if preferred. The foods that tend to be tolerated better are cereals (rice and wheat), potatoes, bread, lean meat, vegetables, fish, yoghurt and fruit. Avoid foods that are difficult to digest, with lots of fat and sugar.

Go to A&E

• If they vomit a lot and do not tolerate solid foods or liquids, or if they vomit despite not having eaten or drunk anything.
• If the vomit is green, bloody or looks like coffee
• If they are sleepy, excessively depressed, very thirsty, cry with no tears, pass little urine, have sunken eyes or are hard to wake up.
• If stools are very watery, abundant and frequent, meaning that the child is unable to recover the fluids lost
• If they have a high fever that does not go down with the usual antipyretics
• If they are younger than 3 months and have vomited two or more times after feeding
• If vomit is accompanied by a lot of abdominal pain and a headache

Further recommendations

To recover lost fluids, do not use homemade solutions or commercial drinks. Solutions prepared specifically for rehydration are recommended.

Do not administer medications for vomiting or diarrhoea without consulting a paediatrician.

Fever is not an illness in itself, but the body’s defence response. Treatments for fever serve to alleviate the symptoms.

Thermometer

To find out if you have a fever, always use a thermometer. A digital thermometer is best. To use it, place it in the ill person’s armpit for approximately two minutes, until it beeps. In breastfeeding babies it can be placed in the rectum, but bear in mind that if done this way a fever is anything above 38°C.

What should I do if my child has a fever?

• Give them juice or water
• If they do not want to eat, do not force them to.
• Keep your home at a comfortable temperature and avoid excessive clothing 

When do I need to use antipyretics?

If, despite having applied the above measures, the fever remains higher than 38ºC and the child is generally unwell, antipyretics may be administered.

The medication used most often is paracetamol or ibuprofen. Both can be administered in drops or syrup.

What do you need to bear in mind when administering antipyretics?

• A fever does not always need to be lowered with antipyretics, only if the child is experiencing discomfort, which is normally between 38ºC and 38.5ºC.
• The aim is not for the child to feel the same as they do when they do not have a fever, but just to make them more comfortable.
• Use the antipyretic doses recommended by your paediatrician and make sure they are taken at the right times, even if the fever appears before the next dose is due.
• It is better to administer antipyretics via the mouth (orally) than the anus (rectally). The body absorbs them better if taken orally.
• It is not proven that alternating medication is more effective in treating fever and discomfort. And doing so may cause confusion when administering it, so it is advisable not do so regularly.
• Ibuprofen can be used in children older than 6 months.
• A paediatrician must examine children under 3 months before administering paracetamol.
• It is not advisable to administer antipyretics to prevent reactions to vaccines.
• Keep medication away from children.

When should I go to A&E?

• If the baby is less than 3 months old.
• If the child is very irritable, distressed or very sleepy.
• If they are having convulsions.
• If they complain of an intense headache and vomit several times.
• If they are having respiratory difficulty.
• If spots appear on the skin and do not disappear with pressure.
• If their temperature is equal to or more than 39°C or persists for more than two days.

In summary, when we have an infection and the body raises our temperature, it causes what is known as a fever. Antipyretics do not cure the infection, but they can alleviate the symptoms. 

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What do you need to bear in mind if you have meningitis?

The risk of contracting meningitis increases if you come into close contact with someone who has it (if you sleep in the same room, live in the same house, kiss on the cheek, etc.), but there is no need to disinfect objects or areas because meningococcus bacteria do not live long outside of the human body.

The measures to prevent this illness are:

• Chemoprophylaxis (antibiotic treatment)
• Vaccination 

With meningitis, the appropriate measure is to administer antibiotics to the family and other people who live with the affected person.

If the illness was caused by meningococcal group B, the only preventive measure, and the most common in Spain,  is chemoprophylaxis, which aims to eliminate the microorganism from the pharynx. This stops it from spreading, in the space of a few days, between the people who have taken the medication.

If the illness was caused by meningococcal group C, as well as administering chemoprophylaxis, people close to the affected person will be vaccinated if they have not already been so.

If there is evidence that someone has had intimate contact with the patient in the ten days prior to the occurrence of the disease and they have not been administered chemoprophylaxis, healthcare staff must be informed.

What do you need to bear in mind if you take tuberculosis (TB) drugs or if you want to detect side effects early?

Currently, tuberculosis (TB) drugs are safe and effective, and the majority of people take them without any problems. In some cases side effects may appear, so it is important to follow the treatment plan under supervision and see a doctor in case of doubt.

Once treatment begins, and to make sure it has the desired result, follow the instructions below:

• Take medicine on an empty stomach (30 minutes before breakfast). 
• Do not take it alongside any antacids or gastric protectors. 
• If you are diabetic or have gout, tell your doctor. 
• The medication may cancel out the effect of hormonal contraceptives; where required, you will need to take other measures to avoid pregnancy. 
• Tell medical personnel about any other medication you may be taking. 
• Even if you feel better, continue treatment for the time indicated. If for any reason you are not able to take your medication, tell medical personnel beforehand. 
• The use of other medicines (cough medicine, antipyretics, natural remedies, etc.) may result in intolerances (digestive, kidney, etc.). It is important that you consult your doctor before taking any other medication. 
• Do not drink alcoholic drinks during treatment. 
• Use high factor sun cream when exposed to sunlight. 

Warnings 

Urine, faeces, sweat and tears may be red/orange in colour. This change is normal and will disappear when the treatment comes to an end.

Advise medical personnel if you have any of these symptoms

• Loss of appetite 
• Nausea 
• Diarrhoea 
• Abdominal pain 
• Gastric discomfort 
• Eyes or skin become pale 
• Joint pain or inflammation (knees, ankles, etc.) or significant
• skin outbreaks 
• Blurred vision or changes in perception of colours

Què has de tenir en compte per prevenir les infeccions de transmissió sexual?

La societat demana cada vegada més informació sobre les infeccions de transmissió sexual: l’única manera d’evitar-les és amb la prevenció, però també és important proporcionar informació sobre pràctiques de sexe segur.

Les infeccions de transmissió sexual figuren entre les cinc categories principals per les quals els adults cerquen atenció mèdica. Comprenen una sèrie de patologies, d’etiologia diversa, en les quals la transmissió sexual és rellevant des del punt de vista epidemiològic. Tot i això, de vegades pot haver-hi altres mecanismes de contagi, com ara la transmissió perinatal o parenteral.

Les intervencions d’assessorament i els enfocaments conductuals representen la prevenció primària contra les ITS, que inclouen:

• Assessorament sobre pràctiques sexuals més segures, reducció de riscos i promoció de l’ús del preservatiu
• Educació sexual integral, amb assessorament abans i després de les proves d’ITS
• Assessorament i educació sexual adaptats a les necessitats dels adolescents
• Intervencions dirigides a grups de poblacions clau, inclosos treballadors sexuals, homes que tenen sexe amb homes i consumidors de drogues injectables.

Així mateix, l’assessorament pot millorar la capacitat de les persones per reconèixer els símptomes de les ITS, amb la qual cosa augmentaran les probabilitats que aquests sol·licitin atenció i animin les seves parelles sexuals a fer-ho.

Malauradament, la manca de sensibilitat de la població i l’arrelat estigma generalitzat vers les ITS segueixen dificultant l’eficàcia de les intervencions sanitàries.

L’estudi dels contactes en les ITS és el procés pel qual les parelles sexuals d’un pacient diagnosticat amb una ITS són identificades i informades del risc de contraure aquesta infecció, i se’ls ofereix atenció i tractament per un professional sanitari. L’estudi de les parelles té beneficis clínics i de salut pública per tres raons:

• S’evita la reinfecció del pacient.
• Es diagnostica i es tracten persones infectades sense símptomes.
• Es trenca la cadena de transmissió de la infecció.

L’epidemiologia de les ITS està canviant en els últims anys i s’observa una nova emergència d’aquestes infeccions. Aquest fenomen va associat a les noves pautes de comportament: l’ús de noves tecnologies per a la cerca de parelles sexuals, l’alta mobilitat de la població, la relaxació en l’ús del preservatiu, etc.

El panorama anterior fa inqüestionable l’adopció de noves estratègies de control i prevenció, entre les quals hem d’incloure els estudis de contactes i tota la seva riquesa metodològica basada en l’evidència científica.

What do you need to bear in mind if you have complex glomerular disease or you are caring for someone who does?

On the one hand, the function of the kidneys is to eliminate impurities from the body through the urine, and regulate the amount of liquid and chemical elements that we need, such as sodium, potassium, phosphorus or calcium. 

On the other hand, the kidneys also help in regulating blood pressure by activating vitamin D, which is required to maintain healthy bones, and producing erythropoietin, which is required to produce red blood cells in the bone marrow.

When the kidneys do not work properly, the impurities we generate and the water that the kidneys cannot eliminate accumulates in the blood and the tissues, and this causes major disruptions to the patient’s general health, fluid retention and hypertension. They are also unable to properly get rid of some medications we take, which can accumulated in the body, increasing the risk of side effects. 

As the kidneys are unable to help make vitamin D, or to retain phosphorous,  the bones are weakened. The kidneys are also unable to produce erythropoietin and therefore anaemia appears.

The main types of renal replacement therapy are:

• Haemodialysis
• Peritoneal dialysis
• Kidney transplant

Where patients will not benefit from renal replacement therapy,  conservative treatment will be carried out, aimed at controlling the different disorders and symptoms that appear during evolution of the illness.

The majority of cases of glomerulonephritis cannot be prevented, although a healthy lifestyle is advised, as promoted by the Spanish National Health System:

• Keep glycaemia levels (blood sugar) and blood pressure within normal range.
• Avoid toxic habits
• Do moderate physical exercise
• Avoid obesity

In addition, the application of dietary and pharmacological measures can help prevent or decrease the progression of the illness:

Dietary measures that should be taken

Maintain a balanced diet and limit:

• Salt. As substitutes, the following items can be used to eliminate or reduce consumption:
  • Use vegetables as seasoning: celery, garlic, leek, onion, tomato, carrot.
  • Add aromatic herbs and spices: if the herb is dry, it is better to add it towards the end of cooking, as this will make the most of its flavour.
  • Flavour oil.

• Potassium. Part of the potassium in food can be removed by:
  • Water: once peeled and cut, soak foods. The longer foods are soaked for and the smaller the pieces, the more potassium will be lost. They can also be washed several times, changing water.
  • Boiling: boiling foods removes potassium, as it stays in the water. You should therefore avoid consuming cooking water. It is better to change water after 10-15 minutes of boiling foods, adding clean boiling water.
  • Frozen foods: frozen vegetables and legumes have less potassium than fresh ones, although they retain many of their other properties.
  • Preserved food: when food is preserved in liquid, the potassium remains in the liquid and the food contains less. This liquid should be poured away.

• Proteins. Although proteins are required for repairing and creating cells and tissues, as well as for the proper functioning of the immune system:
  • Dried fruits and nuts are not recommended as they have a high potassium content.

• Fluids. Fluid intake should be adjusted to each particular case:
  • Reducing the sensation of thirst.
  • Drinking only when thirsty and drinking small amounts.
  • Not getting into the habit of drinking.
  • Taking medication with the liquids in meals and using the smallest amount possible.
  • Using citrus slices to stimulate salivation and moisten the mouth.
  • Adding a few drops of vinegar to water.
  • Chewing sugar free gum.
  • Adding a few drops of lemon juice to ice cubes before putting them in the freezer.
  • Freezing fruit pieces.
  • Reducing the intake of drinks such as coke, orange juice, etc., and replacing them with ice tea and homemade lemonade.
  • Avoiding alcohol.

Pharmacological measures that should be taken

• Patients many need to take the same medications as patients undergoing dialysis. Some drugs may include:
  • Hypotensors: drugs to reduce blood pressure (angiotension converting enzyme [ACE] inhibitors or angiotension receptor blockers [ACB]).
  • Corticosteroids: better known as steroids, these are anti-inflammatory medications.
  • Immunosuppressants: drugs that inhibit the immune system.

• Medication that helps patients to alleviate the symptoms,  such as itching, pain, etc., may also be taken.

• Other measures may also be adopted, such as:
  • Avoid consuming nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Avoid contact with organic solvents and polluting substances, such as mercury.

Other related health information

• Looking after the peritoneal dialysis (PD) incision and catheter.
• Looking after a tunnelled central venous catheter (CVC)
• Looking after an arteriovenous fistula (AVF)
• Training and health education for patients and carers in PD treatment.
• Recommendations on discharge for patients with nephritic syndrome
• Advice for patients undergoing immunosuppressive therapy 

What do you need to bear in mind if you have resistant osteoarticular infections?

When the patient is discharged, nursing staff will give them all the support and information they need to be able to look after the wound themselves. Most patients will be fitted with an external fixator that needs daily care, so healthcare staff will emphasise the importance of hygiene in the affected area, which should be cleaned daily and the correct dressing applied.

If patients are not independent and do not have a relative or carer to look after them, the local health authority will be contacted (through the PREALT discharge preparation unit), so that they may be provided with nursing care. If patients are being treated with intravenous medication, the Hospital at Home Unit will be contacted to follow up and provide the relevant treatment.

It is also necessary to explain the importance of taking the medication prescribed. On being discharged, most patients will receive long-term oral antibiotics (prescribed by the Infectious Diseases Unit) and they are reminded of the importance of maintaining a fixed schedule and not forgetting to take their medication.

They are also reminded of the need to maintain healthy habits, such as:

• Being well hydrated
• Eating properly (protein-based diet)
• Stopping toxic habits (should they have any), such as alcohol and tobacco

What do you need to bear in mind to prevent Zika virus?

The advice to prevent infection with Zika virus is particularly aimed at pregnant women or those thinking of becoming pregnant in the short to medium term. The possibility of transmitting the infection to the foetus means that pregnant women are the most vulnerable group. For this reason, you are advised to:

• Avoid travelling to countries where there is a risk of being infected while you are pregnant.
• Inform a healthcare professional if you have already travelled to any the affected areas.
• Use a condom for the entire pregnancy if your sexual partner has travelled to countries affected by Zika virus.

Mosquito bite prevention

• Dress in clothes that cover most of your body and wear a hat all day to protect your skin as much as possible from exposure to mosquitoes.
• Use authorised repellents, following the manufacturer’s instructions for their use and reapplication indicated on the product.
• Avoid being outside unnecessarily during the most active times of day for mosquitoes (first thing in the morning and late afternoon).
• Sleep in air conditioned accommodation, as mosquitoes tend to avoid the cold, or place mosquito nets around the bed, doors and windows.

Mosquito proliferation prevention

Another way of preventing mosquito bites is to avoid proliferation of mosquitoes, which you can do by finding out and periodically checking the areas where these insects reproduce. Once breeding points are located, the measures should focus, as appropriate, on:

• Avoiding and/or draining any accumulation of water there may be in the subsoil of accommodation.
• Emptying or covering objects that may accumulate water.
• Emptying or refreshing water weekly in the case of fixed objects or containers that may accumulate water and covering, with a lid or mosquito screen, those that cannot be emptied.
• Keeping swimming pools, ponds and other bodies of water in correct hygiene conditions.

What do you need to bear in mind if you have acute bronchiolitis?

Acute bronchiolitis is a respiratory tract infection common in infants under two. This infection, caused by RSV, manifests itself in mild or moderate catarrhal symptoms, although if it is not treated, it may progress and cause serious bronchiolitis or pneumonia.

The symptoms of acute bronchiolitis may vary depending on the patient’s age:

• In adults and the majority of healthy infants: upper respiratory symptoms (rhinitis, mild cough, minor wheezing)
• In breastfeeding and premature babies: normally, lower respiratory symptoms (bronchiolitis, pneumonia)

This virus may be transmitted in two ways:

• Directly: through contact with secretions from an infected individual (wet mode)
• Indirectly: through contact with surfaces, such as furniture (for example, those that have been exposed to infectious secretions)

The preventive measures to avoid transmission of the virus are:

• Hand hygiene: hands should be washed before touching the child.
• Toys should be cleaned, especially after having been used by other infected children or adults.
• Personal utensils (plates and feeding bottles) should be washed properly and specific utensils used for the infant that are different to those used by adults.
• (Paper) disposable tissues should be used and immediately disposed of (not re-used).
• Physical contact with the infant should be avoided by people with respiratory symptoms or fever. Infection can be avoided if a distance of 1.8 m is maintained from the person with symptoms.
• Enclosed environments and crowds should be avoided.
• Avoid exposure to tobacco smoke.
• Breastfeeding should be encouraged, as it protects against infections.

Admission to hospital is more likely in infants belonging to high risk groups:

• Children born premature
• Children with chronic pulmonary illnesses
• Children with congenital heart disease

In the above cases, administering prophylaxis with palivizumab is recommended, as it is proven to reduce hospital admissions for RSV.

Palivizumab

• Palivizumab is a passive immunisation that prevents infections due to RSV (it is not a vaccine).
• It does not normally have adverse effects and it does not interfere with the vaccination schedule.
• Care must be taken to ensure that the doses are correctly given, since each dose last approximately 30 days.
• It must be administered by a healthcare professional in a hospital clinic (it cannot be administered in a primary care centre).
• The dose given will depend on the child’s weight, and will be administered once a month during an epidemic period (five doses in total) and by intramuscular injection to the face and/or outside thigh.