Severe infective gastroenteritis in a young man

As a GP working in both your own practice and the local emergency department, you commonly assess and treat patients with gastroenteritis from all age groups.

The case

One morning, a young man is wheeled straight from triage to an acute-care bed. The triage nurse quickly informs you that he is 32 years of age and presented with diarrhoea and abdominal pain, having recently returned from overseas. His blood pressure is 80/40 mmHg, heart rate 140 beats/minute, respiratory rate 24 breaths/minute and temperature 38.5^oC.

You move to his bedside and initial assessment reveals he has dry mucous membranes and appears lethargic. He is severely dehydrated and has sepsis, so while you take a history, you insert an intravenous cannula and prescribe a one-litre bolus of normal saline. You send specimens for testing for venous blood gas levels, a full blood count, electrolyte and creatinine levels, liver function, lipase level and blood cultures.

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