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I know in my BF's case, it was the stomach flu and the need to vomit that preceded his episode...his white blood cell count was high at the hospital, plus I got it a day and a half later w/ same symptoms, minus the loss of conciousness. Each of the three times this has happened, it was preceded or accompanied by the urge to vomit, and it seems as though there was a trigger each time (alcohol and stomach flu). I am not sure what causes what first, but I do think it is closely related to dehydration. For example, drinking alcohol or having a fever w/ the stomach flu can dehydrate you, which can lead to low BP, tachycardia, and a weak pulse. If you have a sensitive or heightened vaso vagal response, your body may begin to shut down and conserve resources prematurely, which can lead to the greater drop in BP, heart rate, and loss of conciousness. I also know that in my BF's case, IV fluids made all the difference-he felt much better and his symptoms subsided (except for the stomach flu) shortly after an IV was started. It seems that everyone's situation is a bit different, yet I am reading a lot about the dehydration piece as a common factor for many.