Mr. J.R. is a 73-year-old man, who was admitted to the hospital with clinical manifestations of gastroenteritis and possible renal injury. The patient’s chief complaints are fever, nausea with vomiting and diarrhea for 48 hours, weakness, dizziness, and a bothersome metallic taste in the mouth. The patient is pale and sweaty. He had been well until two days ago, when he began to experience severe nausea several hours after eating two burritos for supper. The burritos had been ordered from a local fast-food restaurant. The nausea persisted and he vomited twice with some relief. As the evening progressed, he continued to feel “very bad” and took some Pepto-Bismol to help settle his stomach. Soon thereafter, he began to feel achy and warm. His temperature at the time was 100. 5°F. He has continued to experience nausea, vomiting, and a fever. He has not been able to tolerate any solid foods or liquids. Since yesterday, he has had 5–6 watery bowel movements. He has not noticed any blood in the stools. His wife brought him to the ER because he was becoming weak and dizzy when he tried to stand up. His wife denies any recent travel, use of antibiotics, laxatives, or excessive caffeine, or that her husband has an eating disorder. Ms. P.C. is a 19-year-old white female who reports a 2-day history of lower abdominal pain, nausea, emesis and a heavy, malodorous vaginal discharge. She states that she is single, heterosexual, and that she has been sexually active with only one partner for the past eight months. She has no previous history of genitourinary infections or sexually transmitted diseases. She denies IV drug use. Her LMP ended three days ago. Her last intercourse (vaginal) was eight days ago and she states that they did not use a condom. She admits to unprotected sex “every once in a while.” She noted an abnormal vaginal discharge yesterday and she describes it as “thick, greenish-yellow in color, and very smelly.” She denies both oral and rectal intercourse. She does not know if her partner has had a recent genitourinary tract infection, “because he has been away on business for five days. Microscopic Examination of Vaginal Discharge (-) yeast or hyphae (-) flagellated microbes (+) white blood cells (+) gram-negative intracellular diplococci

In the case scenarios presented, two patients, Mr. J.R. and Ms. P.C., present with different symptoms and complaints. Mr. J.R., a 73-year-old man, has symptoms of gastroenteritis and possible renal injury, while Ms. P.C., a 19-year-old female, has lower abdominal pain, nausea, emesis, and a malodorous vaginal discharge. This analysis will focus on the possible diagnoses and treatment options for each patient based on their symptoms and laboratory findings.

Case 1: Mr. J.R.
Mr. J.R. presents with symptoms of gastroenteritis, including fever, nausea with vomiting and diarrhea, weakness, dizziness, and a metallic taste in the mouth. These symptoms are consistent with an acute gastrointestinal infection, most likely caused by ingesting contaminated food. The fact that Mr. J.R. experienced symptoms shortly after consuming burritos from a fast-food restaurant suggests that food poisoning is the likely cause.

The presence of fever, watery bowel movements, and the absence of blood in the stools further support the diagnosis of gastroenteritis. The watery bowel movements are indicative of increased fluid secretion in the intestines, which is a common response to infection. Additionally, the absence of blood suggests that there is no significant damage or inflammation in the gastrointestinal tract.

Treatment for gastroenteritis typically involves symptomatic management to alleviate nausea, vomiting, and diarrhea. Intravenous fluid therapy may be necessary if the patient is dehydrated. Antiemetic medications can help relieve nausea, while antidiarrheal agents may be used to alleviate diarrhea. It is important to closely monitor the patient’s fluid balance and electrolyte levels, as they can become imbalanced during severe cases of gastroenteritis.

In order to confirm the diagnosis and rule out other possible causes, further laboratory tests may be performed, such as stool culture to identify the specific infectious agent responsible for the gastroenteritis. Renal function tests should also be conducted to assess for possible kidney injury, as indicated in the patient’s chief complaints.

Case 2: Ms. P.C.
Ms. P.C. presents with lower abdominal pain, nausea, emesis, and a malodorous vaginal discharge. She reports being sexually active with one partner and recalls having unprotected intercourse eight days ago. The symptoms she describes, along with the laboratory findings, suggest a possible sexually transmitted infection (STI).

The heavy, malodorous vaginal discharge, along with the presence of white blood cells and gram-negative intracellular diplococci on microscopic examination, is highly suggestive of Neisseria gonorrhoeae infection, a common bacterial STI. The greenish-yellow color of the discharge further supports this diagnosis.

It is important to note that local patterns of STI prevalence and antimicrobial resistance should be taken into consideration when deciding on appropriate treatment. Empirical treatment with dual therapy, including an injection of a third-generation cephalosporin and oral azithromycin or doxycycline, is usually recommended for suspected gonococcal infections. This treatment strategy is aimed at preventing the development of antimicrobial resistance. However, confirmatory testing, such as nucleic acid amplification tests, should be performed to identify the specific causative organism and guide further treatment decisions.

In conclusion, Mr. J.R. and Ms. P.C. present with different symptoms and laboratory findings, suggesting different diagnoses. Mr. J.R. likely has gastroenteritis, which is commonly caused by food poisoning. Treatment for gastroenteritis involves symptomatic management and monitoring for fluid and electrolyte imbalances. Ms. P.C. presents with symptoms consistent with a possible Neisseria gonorrhoeae infection, a sexually transmitted infection. Empirical treatment with dual therapy is recommended, but confirmatory testing should be performed to guide further treatment decisions. Overall, appropriate diagnosis and treatment are crucial in ensuring optimal outcomes for patients presenting with these symptoms.