Stomach bug in adults (gastroenteritis): treatment online in Puerto Rico

A stomach bug (gastroenteritis) is an infection of the stomach and intestines, usually caused by a virus. Although it is called "stomach flu", it isn’t caused by the flu virus. The most common cause of diarrhea in adults is norovirus, which is highly contagious and causes outbreaks in hospitals, schools and on cruise ships. In young children, rotavirus is the leading cause. COVID-19 can also cause stomach symptoms.

It spreads through contact with a sick person, contaminated food or water, and shared surfaces and utensils. Most people with norovirus get better within 1 to 3 days. Older adults and people with weakened immune systems are at higher risk of complications.

Request a visit online 24/7 — we confirm your time by email or text.

A stomach bug is handled in a US$79 doctor visit, the same price for every age, with no membership. You pay by card when you request the visit, and you get a full refund if the visit can’t take place. A doctor’s note after your visit is included at no extra charge.

We do not bill insurance; the lab and the pharmacy charge separately. See all prices. The service is run by The Health Initiative, a nonprofit.

Symptoms usually start 4 to 48 hours after exposure. The most common are:

• Diarrhea
• Vomiting
• Nausea
• Belly pain or cramps
• Fever
• Headache and body aches

The most important thing is replacing lost water and salts. Drink an oral rehydration solution (an electrolyte solution from the pharmacy) in small, frequent sips, following the label; drinking a lot at once can bring on more vomiting. Skip juice, soda, flavored gelatin and broth: they don’t replace lost salts. When you are hungry, eat small amounts often: cereals, bread, potatoes, lean meat, plain yogurt, bananas and vegetables.

Antibiotics don’t work against viruses. Over-the-counter medicines can slow diarrhea, but don’t use them without talking to the doctor if you have bloody diarrhea, fever or severe diarrhea. If you take a diuretic (water pill), ask whether to pause it; never stop a prescription medicine without checking.

If diarrhea lasts several days, has blood in it, or the doctor suspects bacteria or a parasite, we give you a lab order for a stool test at a lab near you and review the result with you.

Wash your hands with soap and water for at least 20 seconds, especially after using the bathroom and before handling food: hand sanitizer doesn’t work well against norovirus. Clean surfaces with a bleach solution (5 to 25 tablespoons of household bleach per gallon of water) and leave it on for at least 5 minutes. Don’t prepare food for others until 48 hours after your symptoms stop.

After a hurricane or flood, drink bottled, boiled or treated water. To boil it, the CDC says to bring clear water to a rolling boil for 1 minute. If there is a boil water advisory in your area, follow those steps.

In Puerto Rico, vomiting 3 or more times in 24 hours, together with belly pain, is also a dengue warning sign, especially after a few days of fever. Read dengue warning signs.

Food poisoning causes almost the same symptoms: diarrhea, stomach pain or cramps, nausea, vomiting and fever. According to the CDC, how soon it starts depends on the germ: 30 minutes to 8 hours for staph toxin, 6 hours to 6 days for Salmonella, and up to 2 weeks for Listeria. So it was not always "the last thing you ate".

If you got sick after eating reef fish such as barracuda, grouper or snapper and you also have tingling or cold things feel hot, it may be ciguatera, which is not a virus and is not destroyed by cooking. If it started while traveling, read traveler's diarrhea. Visitors with food poisoning in San Juan or anywhere on the island can be seen by video.

Get checked if you have bloody diarrhea, diarrhea for more than 3 days, a fever over 102 °F (38.9 °C), vomiting so often you cannot keep liquids down, or signs of dehydration. With no emergency signs, the doctor can evaluate you by video.

This page is for adults. We also see children of all ages, but babies and young children dehydrate faster and the warning signs depend on age: see our page on diarrhea and vomiting in children. Don’t give children over-the-counter diarrhea medicines.

The doctor evaluates your child by video with you on camera. Patients under 21 need a parent or legal guardian on camera with ID. See our online doctor for kids.

For safety: a baby under 3 months with a temperature of 100.4 °F (38 °C) or higher needs the emergency room right away.

These signs can mean serious dehydration or another cause that needs care right away. For your safety, go to the emergency room or call 911. See when to go to the ER.

• Blood in the stool or vomit
• Can’t keep fluids down
• No urine for 8 hours or more
• Dizziness or fainting when standing up
• Confusion or unusual drowsiness
• Severe, constant belly pain
• Vomiting 3 or more times in 24 hours after days of fever (possible dengue)