vomiting-diarrhea

name: vomiting-diarrhea description: Use when a caller reports vomiting, diarrhea, or both, in themselves or a dependent of any age, with or without accompanying fever. Produces a three-way next-action decision — Call (emergency or hotline), Go (open pharmacy), or Wait (home self-care with ORS and monitoring) — with the Yorukusu safety boundary on every output. Inputs include age, episode frequency and severity, onset timing, dehydration markers (urine output, activity, mucous membranes), concurrent symptoms (fever, blood, severe abdominal pain), and the caller's Personal Health Context. Never outputs a diagnosis and never recommends prescription medication.

Vomiting and Diarrhea Triage

Yorukusu does not diagnose. Pharmacist-informed, not pharmacist-replacing.

When to invoke this skill

Invoke when the caller's message indicates vomiting, diarrhea, or the combination, in themselves or a dependent of any age.

• [TODO-TM: enumerate the trigger keywords and phrasings in Japanese and English — including "吐く", "下痢", "お腹を下した", "vomit", "throwing up", "loose stool" and their common variants. Specify how to disambiguate from acute abdominal pain without GI output (which is a different triage path) and from infant spit-up (which is often non-pathologic). List the minimum confidence threshold before invoking versus asking a clarifying question.]

Required inputs

If any field is missing, ask the caller in plain language before deciding.

1. Age of the person with symptoms (years and months for infants).
2. Vomiting pattern: frequency, how long, is it keeping any fluid down.
3. Diarrhea pattern: frequency, appearance, is there any blood.
4. Onset timing and any suspected trigger (food, sick contacts, travel).
5. Dehydration markers: urine output in the last several hours, tears, mucous-membrane moisture, activity level, behavior change.
6. Concurrent symptoms: fever, abdominal pain (severity and location), lethargy, altered consciousness, rash.
7. Personal Health Context: known allergies, chronic conditions, current daily medications (especially any that affect fluid balance or immune status).

Red-flag screening — output CALL immediately

Run red-flag screening FIRST, before any other branching. If any flag is positive, output CALL with that flag as the reason and stop.

• [TODO-TM: define the complete red-flag criteria set, including age-banded dehydration severity thresholds (infant thresholds are much lower than adult), presence of blood in vomit or stool, bile-stained vomit in infants, signs of severe abdominal pathology (distension, guarding, persistent localized pain), altered consciousness or profound lethargy, inability to tolerate any oral intake over a specified window, and immunocompromise or chronic- condition modifiers. Include the exact caller-facing phrasing (Japanese primary, English secondary) for each flag and the emergency number to dial.]

Decision logic (no red flags)

After red flags are cleared, branch to one of CALL, GO, or WAIT.

• [TODO-TM: specify the decision tree for the non-red-flag path, stratified by age bands (infant, toddler, school-age child, adolescent, adult, elderly). Define the thresholds on episode frequency, tolerance of small sips, dehydration markers, duration since onset, and PHC modifiers (diabetes, kidney disease, immunosuppression) that move a case between branches. Document edge cases — recent antibiotic exposure, suspected food poisoning versus viral gastroenteritis, travel history — explicitly.]

OTC guidance (WAIT and GO branches)

When the branch is WAIT or GO, the skill may surface OTC oral rehydration and symptomatic-care guidance drawn ONLY from the Yorukusu pre-approved OTC list. Never surface prescription medication.

• [TODO-TM: specify the pre-approved OTC options (oral rehydration salts, probiotic preparations, and any age-appropriate antiemetic or antidiarrheal considerations that are OTC in Japan), the caller-facing dose and preparation guidance (including how to prepare ORS when a sachet is not available), contraindications that escalate the branch (very young infants, suspected bacterial etiology), and the exact wording around "verify with the on-duty pharmacist before giving" for the GO branch. Include the named products (generic and common trade names) to surface.]

Output format

Every response from this skill MUST be a structured triage card with these fields, in this order:

1. decision: one of CALL, GO, WAIT.
2. reason: 1-2 sentences, caller-facing, in plain language. NEVER contains diagnostic language (phrasings like "appears to be X" or "likely Y" are prohibited).
3. next_action: a concrete single step — the phone number to dial, the open pharmacy to route to in the map, or the OTC guidance block.
4. exit_criteria: conditions under which the caller should re-run triage (required for WAIT and GO).
5. safety_boundary: the exact string "Yorukusu does not diagnose. Pharmacist-informed, not pharmacist-replacing."

Non-goals

• Never output a diagnosis.
• Never recommend a prescription medication.
• Never omit the safety_boundary field.
• Never skip red-flag screening.
• Never continue past a positive red flag on the same branch.