Welcome to this month’s What’s Your Diagnosis Challenge!
Case Presentation: Diagnosis and Management of Acute Gastroenteritis
You are working in the ED on a busy morning when you meet an otherwise healthy 42-year-old man reporting 2 days with 5 to 10 watery, nonbloody, unformed stools and persistent nausea, anorexia, and 1 to 2 episodes of nonbloody emesis each day. He is mildly tachycardic, but afebrile, and is normotensive. He is alert and conversant but appears mildly uncomfortable. He has dry mucous membranes and diffuse abdominal pain, with minimal tenderness on exam. He denies any recent hospitalizations, antibiotic use, foreign travel, or sick contacts.
The patient requests that you ?check blood work? and provide him with IV fluids and antibiotics for his infection. You wonder how best to educate him about the best use of his time and healthcare resources for his condition?
You explained to the 42-year-old man that one of the benefits of being relatively young, healthy, well-appearing, and having a history without significant risk factors is that there is no benefit to laboratory testing, which will only increase the time and expense of his ED visit. You gave him ondansetron 4 mg ODT, and after 1 hour, you gave him loperamide 4 mg PO. He was then able to drink 1 L of water without vomiting. He appeared euvolemic and his tachycardia resolved. He reported that his abdominal discomfort had improved, and he had no tenderness on repeat exam. He was discharged, following a discussion of the recommended supportive care regimen, as well as return precautions and the importance of follow-up for re-examination and to ensure resolution of symptoms. You called him 2 days later, and he reported that all symptoms had resolved, and he was back to work.
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Last Updated on July 9, 2020