Case history
Case history #1
A 35-year-old man comes to the emergency department with a history of nausea, vomiting, and watery diarrhea of a 1-day duration. The patient and his wife have just returned from a Caribbean cruise, and his wife also has mild diarrhea. 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 is 110/70 mmHg. His abdomen is soft and nontender, 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 nonbloody diarrhea of a 1-day duration. She complains of generalized body aches, chills, and fatigue. Past medical history includes hypertension and coronary artery disease. Blood pressure on examination is 100/60 mmHg and heart rate is 110 beats per minute. Abdomen is nondistended and is nontender. Her roommate in the nursing home has also had diarrhea for 2 days.
Other presentations
Foodborne or waterborne outbreaks of diarrheal illness can occur in the workplace, daycare centers, residences, schools, and 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 diarrheal 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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