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A 7-year-old boy presents with diarrhea and vomiting for the past 3 days. His parents say that the only liquid he can tolerate is lemon-lime soda and that he hasn’t eaten since 2 days ago. His stools are frothy, with mucousy streaks with blood, and happen 4-6 x per day. He has no recent travel history, has not eaten at any restaurants in the last 2 weeks, and has not had any well water. Incidentally, when you ask about pets, you learn that the family does have a pet iguana, and the boy is very fond of it. On physical exam, he has a temperature of 38.2°C, HR = 105, and breathing = 16/minute. He has wrinkles under his eyes, but mucous membranes are still moist. Rectal exam is normal and shows no fissures, and physical exam is otherwise normal. A blood smear reveals a normal CBC without leukopenia. A stool sample reports a gram-negative, non-lactose fermenting bacilli that is motile on rapid screen. The lab is not sure of the serovar, but they estimate it is Salmonella. The parents forcefully request an antibiotic and some fluids. 

What is the appropriate response?

 A. Admit to hospital for IV fluids and start third-generation cephalosporin. 

B. Avoid antibiotics because this is likely a viral infection from E. coli, which is always present in the gut. Administer lots of lemon-lime soda and promote rest. 

C. Prescribe trimethoprim-sulfamethoxazole orally to see if he can keep it down with oral rehydration salts. 

D. Administer fluids, but salmonella gastroenteritis is not treated by antibiotics.

SCIENCE
HEALTH SCIENCE
NURSING
NURS 303

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