October 2024
A 35-year-old man presents to your urgent care with sudden onset of diarrhea for the past 3 days. He reports having loose, watery stools 6 to 8 times per day, and mild abdominal cramping. Although he has nausea, he says has only vomited twice. This patient reports no significant past medical history, no travel history, and no known allergies. On examination, he has mild dehydration, abdominal tenderness (especially in the lower quadrants), and no sign of peritonitis. He says he feels weak and queasy. What is the most appropriate next step for this patient?
- Tell the patient that he must have eaten something bad, send him home to rest and rehydrate, and let it run its course.
- Refer the patient to the emergency department for abdominal ultrasound, intravenous fluids, and antiemetics.
- Begin intravenous antibiotics immediately and initiate EMS protocol.
- Obtain a stool sample and begin oral rehydration therapy (ORT).
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Answer: D. Obtain a stool sample and begin oral rehydration therapy.
The differential for new onset diarrhea is very broad and could be caused by any number of conditions, so it is appropriate to obtain a stool sample and order a stool pathogen panel. Administering ORT is the most appropriate initial management step for this patient’s presentation. This helps address dehydration, which is a common and potentially serious complication of acute gastroenteritis.
You urged the patient to continue drinking fluids such as sports drinks, pediatric hydration products, or broth-based soups, and instruct him to eat as he feels able. Dietary modifications should include the BRAT diet (bananas, rice, applesauce, and toast). You also prescribed antiemetics for his nausea. Upon discharge, you instructed him to return to the urgent care if his symptoms have not improved in 48 hours, or to go to the emergency department if his symptoms worsen. When you received his stool sample results a few hours later, you found that the sample was positive for rotavirus. You called the patient with the result and let him know that he should continue with the treatment you advised.
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Tracey Davidoff, MD, FACP, FCUCM, has practiced Urgent Care Medicine for more than 15 years. She is Board Certified in Internal Medicine. Dr. Davidoff is a member of the Board of Directors of the Urgent Care Association and serves as Co-Editor-in-Chief of the College of Urgent Care Medicine’s “Urgent Caring” publication. She is also the Vice President of the Southeast Regional Urgent Care Association and a member of the editorial board of the Journal of Urgent Care Medicine. At EB Medicine, Dr Davidoff is Editor-In-Chief of Evidence-Based Urgent Care, and co-host of the Urgentology podcast.
