Case history
Case history #1
A 35-year-old man comes to the emergency department with a history of nausea, vomiting, and watery diarrhoea of 1 day's duration. The patient and his wife have just returned from a Caribbean cruise, and his wife also has mild diarrhoea. The patient denies any blood or mucus in the stool. He has chills but no fever. On examination, the patient is afebrile and anicteric, but has dry mucous membranes. His heart rate is 95 beats per minute and blood pressure (BP) is 110/70 mmHg. His abdomen is soft and non-tender, with hyperactive bowel sounds.
Case history #2
A 70-year-old woman is brought to the emergency department from her nursing home with a history of nausea, projectile vomiting, and non-bloody diarrhoea of 1 day's duration. She also describes generalised body aches, chills, and fatigue. Her roommate in the nursing home has also had diarrhoea for 2 days. Past medical history included hypertension and coronary artery disease. BP on examination is 100/60 mmHg and heart rate is 110 beats per minute. Abdomen is non-distended and is non-tender.
Other presentations
Foodborne or waterborne outbreaks of diarrhoeal illness can occur in the workplace, childcare centres, residential care homes, and schools; on cruises; and among diners in restaurants due to food or water contamination. Patients may present with lactose or other food intolerance after a mild diarrhoeal illness. Patients can have a high fever with abdominal pain, in which case an acute abdomen should be ruled out. Person-to-person transmission may cause gastroenteritis in household contacts after the index case. Some patients can present with severe volume depletion, electrolyte imbalance, metabolic acidosis, and acute renal failure.
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