A 24-year-old woman presents to the clinic with a 3-day history of frequent, watery, nonbloody diarrhea, accompanied by mild diffuse abdominal cramping and nausea. She has not experienced fever, chills, or vomiting. She recently returned from a 2-day weekend camping trip in a nearby state park. She has no significant past medical history and takes no medications. Her temperature is 37.1°C (98.8°F), blood pressure is 118/76 mm Hg, and pulse is 82/min. Physical examination shows normal skin turgor and moist mucous membranes. The abdomen is soft and nontender with hyperactive bowel sounds. Which of the following is the most appropriate next step in the management of this patient?
- AEmpirical therapy with oral ciprofloxacin
- BEmpirical therapy with oral metronidazole
- CRoutine stool culture for bacterial pathogens
- DStool examination for ova and parasites
- Oral rehydration therapy and supportive careAnswer
Answer
Oral rehydration therapy and supportive care
The correct response is oral rehydration therapy and supportive care. This patient presents with classic symptoms of acute gastroenteritis. Because her diarrhea is watery, nonbloody, of short duration (< 7 days), and she is hemodynamically stable without high fever or severe abdominal pain, her illness is highly likely to be self-limiting. The mainstay of therapy for uncomplicated acute diarrhea is maintaining adequate hydration. Diagnostic testing (such as stool cultures or ova and parasite exams) and empirical antibiotics are not indicated unless warning signs develop or symptoms become prolonged.
Step-by-Step Solution
Key Concept
Management of uncomplicated acute gastroenteritis revolves around supportive care; empirical antibiotics and stool testing are typically reserved for cases with warning signs (e.g., bloody stools, high fever, severe hypovolemia, or duration > 7 days).