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LEARNING OBJECTIVES

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

  • Identify the most likely causes of acute diarrhea.

  • Establish primary goals for the treatment of acute diarrhea based on signs, symptoms, and patient background.

  • 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.

PATIENT PRESENTATION

Chief Complaint

“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.”

HPI

Mindy Reynolds 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 large chain buffet restaurant. She had granola and yogurt for breakfast and a chicken pesto and avocado sandwich for lunch the day her symptoms began. Her boyfriend ate an assortment of seafood and beef dishes for dinner while she had salads, chicken stir fry, and shrimp. He has felt fine with no symptoms.

She had eaten several plates of food for dinner along with two glasses of iced tea. She had a few sips of her boyfriend’s soda, but did not have any milk or other dairy products. She woke up from sleep with severe nausea and 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 100°F. 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 some 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.

PMH

IBS × 2 years

Migraine headaches ...

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