Case No. 51

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Case No. 51

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Chief Complaint:

Diarrhea and Abdominal Discomfort

Published: June 28, 2017
Case No. 51
Author: Code_Brown
CASE SCENARIO

A 44 year old male with no significant past medical history presents for evaluation of diarrhea for the past 3 days. He states he has been having approximately 10-12 episodes of watery diarrhea per day. He has associated abdominal bloating. He denies nausea, vomiting, fevers, chills, recent travel and antibiotic use. The patient states he was visiting a sick family member in the hospital several days ago. That family member was admitted for diarrhea and dehydration. On examination his blood pressure is 132/84 and his heart rate is 80. He is afebrile. Mucus membranes appear dry. Cardiopulmonary examination is unremarkable. His abdomen is soft, non-tender to palpation throughout, non-distended, and with normal bowel sounds. Laboratory studies are notable for WBC 13, Creatinine 1.2, and lactate of 1.0. Clostridium Difficile PCR testing is positive. The patient denies ever having this in the past.

QUESTION

What is the appropriate treatment for this patient?

IV fluid hydration only
Encourage PO intake and follow-up in 48 hours
Oral Metronidazole
Oral Vancomycin
Oral Vancomycin plus IV Metronidazole
Fecal transplantation