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Which of the following interventions is most appropriate for this patient?
Dr. Shoaib Ahmad Baig
January 10, 2025
🔍 Question of the day
A 12-year-old girl arrives at the emergency department with a 3-day history of fever and diarrhea, having about six bowel movements per day with occasional blood in the stool. Her mother reports a recent camping trip in the mountains with her scout group, during which she consumed primarily chicken and fruits. The mother also mentions the child seems unusually drowsy and confused. She has no known past medical conditions and takes no medications.
Vital signs show a blood pressure of 110/71 mmHg, heart rate of 105 beats/min, respiratory rate of 23 breaths/min, and temperature of 38.8°C (101.8°F). Physical exam findings include dry mucous membranes, cool hands, and weak radial pulses bilaterally. Abdominal examination reveals a soft, non-tender abdomen with normal bowel sounds. Stool culture and gram staining identify oxidase-positive, comma-shaped, gram-negative bacteria.
Which of the following interventions is most appropriate for this patient?
A. Azithromycin
B. Doxycycline
C. Intravenous hydration
D. Levofloxacin
E. Oral hydration
Correct Answer 🎯: Intravenous hydration
• Severe dehydration with altered mental status requires IV fluids for rapid restoration of vascular volume.
• Oral hydration is insufficient due to impaired consciousness (risk of aspiration).
⚙️
Ingestion of Contaminated Food (Campylobacter infection)
⬇
Bacterial Colonization in GI Tract (Comma-shaped, oxidase-positive bacteria)
⬇
Production of Cytotoxins (E.g., cytolethal distending toxin)
⬇
Intestinal Epithelial Damage
🧠Mechanism: Disruption of tight junctions and epithelial cell lysis
⬇
Diarrhea (↑ frequency of bowel movements, 6x/day)
⬇
Occasional Blood in Stool
🧠Mechanism: Damage to mucosa → Microvascular bleeding
⬇
Loss of Fluids and Electrolytes
⬇
Dehydration (Dry mucous membranes, cool extremities, weak pulses)⬇
Systemic Effects (↑ Heart rate, confusion, ↓ BP compensation)
🧠Mechanism: Decreased cerebral perfusion → Altered mental status
⬇
Treatment Prioritization
🧠Key Insight: Clinical signs indicate severe dehydration, requiring immediate IV hydration to restore fluid balance and
perfusion.
⚖️ Explanation of Other Differentials
Differential ⚖️ | Key Features ⚙️ | Why Incorrect? 🔴 |
|---|---|---|
Shigella infection | Bloody diarrhea, fever, cramps | âš– No seizures or severe systemic toxicity to suggest Shigella. |
Salmonella gastroenteritis | Watery/bloody diarrhea, fever, exposure to chicken | ⚖ Stool culture doesn’t indicate Salmonella (non-oxidase bacteria). |
Escherichia coli (EHEC) | Bloody diarrhea, no fever | âš– Fever present, no hemolytic uremic syndrome (HUS) signs. |
Giardiasis | Chronic watery diarrhea, no fever | âš– Symptoms are acute, with fever and bloody diarrhea present. |
đź“ť Flashcards
Stay Hungry, Stay Curious!
Your Brother In This Struggle
Dr. Shoaib Ahmad
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