A 27-year-old woman presents to her physician with 2 days of diarrhea, abdominal cramping, and fever. She attended a family picnic 3 days ago where several attendees developed similar symptoms. Past medical history is unremarkable, and she does not take any medications. Temperature is 38.4°C (101.1°F), blood pressure is 118/74 mm Hg, pulse is 96/min, and respiratory rate is 16/min. Physical examination reveals mild diffuse abdominal tenderness without guarding or rebound. Laboratory studies are unremarkable. She is tolerating oral fluids and appears well hydrated.
Which of the following is the most appropriate initial management?
The correct answer is:
C) Oral rehydration therapy and supportive care
This patient most likely has acute infectious gastroenteritis. The history of a shared food exposure and multiple affected individuals strongly suggests a foodborne outbreak. She has mild illness, remains hemodynamically stable, and is able to tolerate oral fluids. In such patients, supportive care and oral rehydration are the cornerstones of treatment.
Most cases of acute infectious diarrhea are self-limited and resolve without antibiotics. The primary concern is maintaining hydration and electrolyte balance. Diagnostic testing is generally reserved for patients with severe illness, immunocompromise, persistent symptoms, signs of inflammatory diarrhea, or public health concerns. Step 2 frequently tests the principle that most uncomplicated infectious diarrheal illnesses do not require extensive evaluation or antimicrobial therapy.
Answer choice A: Colonoscopy, is incorrect.
Colonoscopy is not indicated for acute self-limited infectious diarrhea. It may be used when evaluating chronic diarrhea or inflammatory bowel disease.
Answer choice B: Intravenous corticosteroids, is incorrect.
Corticosteroids are used for inflammatory conditions such as ulcerative colitis and Crohn disease but may worsen infectious illnesses.
Answer choice D: Surgical consultation, is incorrect.
There is no evidence of perforation, bowel ischemia, obstruction, or another surgical emergency that would necessitate surgical consultation.
Answer choice E: Total parenteral nutrition, is incorrect.
Most patients with infectious diarrhea can maintain nutrition enterally and do not require parenteral support.
Key Learning Point
Most cases of uncomplicated infectious diarrhea are managed with oral rehydration and supportive care rather than antibiotics or extensive diagnostic testing.
