CASE LEARNING OBJECTIVES
Recognize the signs and symptoms of diarrhea
Distinguish between acute and chronic diarrhea
Explain how medication use can lead to diarrhea
Identify the goals of therapy for diarrhea
Develop an appropriate treatment plan for a patient with diarrhea
"I have diarrhea, I think. I have also been throwing up and I have watery stools at different times."
History of Present Illness
Jose Zapata is a 40-year-old Latino male who is a native of Mexico. The patient complains of symptoms described as abdominal pain, vomiting, and loose watery stools occurring at different times. These symptoms have been occurring for a couple of weeks. He reports that he recently went home to Mexico and "ate a lot of vegetables and fruits" that were grown on his parents' land. He also reports feeling a bit sluggish after being home a couple of days, and his mother suggested he drink some aloe vera juice, which he consumed for the first couple of days. He says that he returned to the United States about 2 weeks ago and that he really hasn't noticed a change in the frequency of the bouts of diarrhea.
JZ became a patient at the community clinic approximately 2 months ago. On his initial visit, he described symptoms of polyuria, polydipsia, and weight loss of 10 lb (4.5 kg) over the previous couple of months without trying to lose weight. At that time, a fingerstick was performed in the clinic and the result showed a blood glucose level of 190 mg/dL (10.5 mmol/L). He reports that afterward he came to the clinic on two different occasions to have fingersticks done. The results were 154 mg/dL (8.5 mmol/L) and 172 mg/dL (9.5 mmol/L), respectively. Based on those results, he was started on metformin 500 mg once daily for 7 days, then 500 mg twice daily. He thinks the episodes of diarrhea and vomiting began after the metformin was increased to 1,000 mg twice daily at his last clinic visit. Today he is also feeling "very down" and misses his wife and children.
Type 2 DM diagnosed 6 weeks ago
HTN diagnosed 1 year ago in Mexico
Dyslipidemia diagnosed at the last clinic visit
Father (+) type 2 DM; mother (+) HTN and type 2 DM. His wife and children are all in good health.
Originally a native of Mexico; has been in the United States for 4 years.
The patient has a seventh-grade education; nonsmoker; patient has no health insurance and receives prescription medications through a national chain pharmacy's $4.00 generic drugs.