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LEARNING OBJECTIVES

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After completing this case study, the reader should be able to:

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  • Identify the common causes of acute diarrhea.

  • Establish primary goals for the treatment of acute diarrhea.

  • Recommend appropriate nonpharmacologic therapy for patients experiencing acute diarrhea.

  • Explain the place of drug therapy in the treatment of acute diarrhea and recommend appropriate products.

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PATIENT PRESENTATION

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Chief Complaint

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“I’ve had the runs for a couple of days, along with vomiting. I haven’t been able keep anything down and I feel awful.”

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HPI

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Mindy Colonada is a 25-year-old woman who comes to the Family Medicine Clinic with a complaint of nausea, vomiting, and diarrhea. She had been well until 1.5 days ago, when she began to experience severe nausea that occurred about 6 hours after eating out at a local sushi restaurant. She had eaten a plate of sushi along with two glasses of iced tea. She had a few sips of her boyfriend’s beer, but did not have any milk or other dairy products. She woke up from sleep with severe nausea. She took two tablespoonfuls of Maalox Plus at that time. The nausea persisted, and she began to vomit “several times” with some relief. As the night progressed, she still felt “queasy” and took two extra Prilosec OTC tablets to settle her stomach. She began to feel dizzy, achy, and warm, and her temperature at the time was 38.2°C. These complaints continued to persist and she vomited a few more times. She has not tolerated any solid foods, but she has been able to keep down small amounts of fluid. Since yesterday, she has had four to six liquid stools along with crampy abdominal pain. She has not noticed any blood or mucus in the bowel movements. Her boyfriend brought her to the clinic because she was becoming weak and lightheaded when she tried to stand up. She denies antibiotic use, laxative use, or excessive caffeine intake. She usually drinks bottled water and has not been traveling outside the country. She often experiences stress-related constipation and occasionally (once every 2 months) has loose stools alternating with constipation. These are usually accompanied by abdominal discomfort that is relieved by a bowel movement. She states that this episode is different.

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PMH

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  • IBS × 2 years

  • Migraine headaches × 10 years

  • GERD × 5 years

  • Depression × 3 years

  • UTI—6 months ago (treated successfully with ciprofloxacin × 10 days)

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FH

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Noncontributory

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SH

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No current tobacco use, uses marijuana occasionally; drinks wine or a mixed drink socially, usually not more than one glass per week; has about two cups of caffeinated coffee daily. She works as an administrative associate for a local bank. Single, sexually active (one partner, monogamous relationship).

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ROS

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