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Lancet 339 , 11281130 (1992)

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The following require emergency care, not a wellness booking: Confusion or altered consciousness Fainting or loss of consciousness Chest pain or difficulty breathing alongside dehydration symptoms No urination for 8 or more hours Fever above 104F combined with dehydration Signs of sepsis, including high fever, chills, rapid heart rate, and confusion together Severe vomiting or diarrhea lasting more than 24 hours without improvement Dehydration in an infant If any of these are present, call 911 or go to the nearest ER immediately