What are the red flags for diarrhoea & vomiting in urgent care?

Signs of dehydration, unable to keep fluids down, AKI risk → IV fluids / admit; Blood in stool, high fever, severe abdominal pain → Colitis, invasive infection — stool culture, consider admission; Recent antibiotics or hospital stay → C. difficile — stool test, isolate; Abdominal pain that came before the vomiting, peritonism → Surgical cause (appendicitis, obstruction); Elderly, immunosuppressed, on diuretics/ACEi/metformin → Higher risk — check U&E, sick-day rules; Recent travel abroad → Travel-related infection — stool culture, malaria if febrile from endemic area

What should I prescribe for diarrhoea & vomiting?

Oral rehydration salts: 200–400 mL after each loose stool (Until settled); Loperamide (adults, no blood/fever): 4 mg initially, then 2 mg after each loose stool (max 16 mg/day) (Up to 5 days); Antiemetic if needed: prochlorperazine: 3–6 mg buccal twice a day (or 5–10 mg oral up to three times a day) (Short course)

Gastroenteritis (Diarrhoea & Vomiting) in Adults | Urgent Care Clinic

Q: What safety-netting advice should I give for diarrhoea & vomiting?

Advise the patient to return or seek help if: Signs of dehydration: very little urine, dizziness, confusion; Blood in stool or vomit; Severe tummy pain; Vomiting for more than 2 days or diarrhoea for more than 7 days.

1Rule out first — red flags

If you find…	…then
Signs of dehydration, unable to keep fluids down, AKI risk	IV fluids / admit
Blood in stool, high fever, severe abdominal pain	Colitis, invasive infection — stool culture, consider admission
Recent antibiotics or hospital stay	C. difficile — stool test, isolate
Abdominal pain that came before the vomiting, peritonism	Surgical cause (appendicitis, obstruction)
Elderly, immunosuppressed, on diuretics/ACEi/metformin	Higher risk — check U&E, sick-day rules
Recent travel abroad	Travel-related infection — stool culture, malaria if febrile from endemic area

2Focused history

Onset, frequency, blood/mucus, duration
Pain (where, before or after vomiting?)
Fluid intake, urine output, dizziness
Food, contacts, travel, recent antibiotics/hospital
Medications: diuretics, ACEi/ARB, metformin, SGLT2i

3Focused examination

Obs incl. postural BP
Hydration: mucous membranes, capillary refill
Abdomen: tenderness, peritonism

4Decide — investigate only if it changes the plan

Investigation	Only if…
Stool sample	Blood/pus, immunosuppressed, recent antibiotics/hospital, travel, persisting > 7 days, suspected outbreak
U&E	Dehydrated, elderly, or on nephrotoxic drugs

5Treat & send home

Management & advice

Oral fluids little and often; oral rehydration solution if at risk
Eat when able
Sick-day rules: pause metformin, SGLT2i, ACEi/ARB, diuretics, NSAIDs while dehydrated (per local sick-day guidance)
Off work/school until 48 h after the last episode; food handlers per public health advice
Hand washing; don’t share towels

Refer / follow-up

Dehydration, blood, severe pain, high-risk → ED / medical team

℞

Discharge prescription (TTO)Typical adult doses — check the BNF/BNFc, allergies, renal function, pregnancy and interactions.

Drug	Dose	Duration / notes
Oral rehydration salts	200–400 mL after each loose stool	Until settled
Loperamide (adults, no blood/fever)	4 mg initially, then 2 mg after each loose stool (max 16 mg/day)	Up to 5 days
Antiemetic if needed: prochlorperazine	3–6 mg buccal twice a day (or 5–10 mg oral up to three times a day)	Short course

6Safety-net

Say it like this

This is a tummy bug and it should settle within a few days. The most important thing is to keep sipping fluids. Stay off work until 48 hours after the last episode. Come back or call 111 if you’re passing very little urine or feel dizzy, see blood, get severe tummy pain, or you’re still vomiting after 2 days.

Come back / call 111 — or 999 if severe — if:

Signs of dehydration: very little urine, dizziness, confusion
Blood in stool or vomit
Severe tummy pain
Vomiting for more than 2 days or diarrhoea for more than 7 days

7Patient leaflets — scan & go

Official NHS pages. Ask the patient to scan the code with their phone camera, or tap “Show to patient” to make it full screen.

Diarrhoea and vomitingnhs.uk/conditions/diarrhoea-and-vomiting

8Document

Diarrhoea & vomiting — clinic note

A structure to document efficiently. It is not a completeness check — use your trust’s system and your clinical judgement.

URGENT CARE — DIARRHOEA & VOMITING PRESENTING COMPLAINT: HISTORY Onset, frequency, blood/mucus, duration: Pain (where, before or after vomiting?): Fluid intake, urine output, dizziness: Food, contacts, travel, recent antibiotics/hospital: Medications: diuretics, ACEi/ARB, metformin, SGLT2i: RED FLAGS (record present / absent) [ ] Signs of dehydration, unable to keep fluids down, AKI risk [ ] Blood in stool, high fever, severe abdominal pain [ ] Recent antibiotics or hospital stay [ ] Abdominal pain that came before the vomiting, peritonism [ ] Elderly, immunosuppressed, on diuretics/ACEi/metformin [ ] Recent travel abroad PMH: DRUG HISTORY: ALLERGIES: SOCIAL (job / who is at home / driving): OBSERVATIONS: RR SpO2 HR BP Temp (NEWS2 ) EXAMINATION Obs incl. postural BP: Hydration: mucous membranes, capillary refill: Abdomen: tenderness, peritonism: INVESTIGATIONS: none required / Stool sample, U&E — result: IMPRESSION: PLAN Treatment / TTO (drug, dose, duration): Advice given: Leaflet given (QR / printed): Diarrhoea and vomiting Follow-up / referral: SAFETY-NETTING (told to return / call 111 / 999 if): - Signs of dehydration: very little urine, dizziness, confusion - Blood in stool or vomit - Severe tummy pain - Vomiting for more than 2 days or diarrhoea for more than 7 days Patient understands and agrees with the plan: Y / N Seen by: Grade: Date/Time:

✓Guidelines

Doses are typical adult doses drawn from the guidance above. Always check the current BNF/BNFc and your local antimicrobial policy.

More infections & medical

Cough & chest infectionBronchitis vs pneumonia, and the NICE rules on antibiotics.Lower UTIDiagnose on symptoms, choose by eGFR and pregnancy, spot pyelonephritis.HeadacheScreen SNOOP, then treat tension and migraine well — and avoid opioids.Calf pain & suspected DVTTwo-level Wells, D-dimer, scan within 4 h or anticoagulate.