What is the appropriate workup for a 52-year-old female (F) who consumed raw oysters and has been vomiting repeatedly since?

Workup for Acute Vomiting After Oyster Consumption

For a 52-year-old female who ate oysters and has been vomiting several times since, the primary workup should include assessment of hydration status, electrolyte panel, and consideration of foodborne illness, particularly vibrio infection.

Initial Assessment

Clinical Evaluation

• Assess for signs of dehydration:
  • Dry mucous membranes
  • Decreased skin turgor
  • Tachycardia
  • Orthostatic hypotension
  • Mental status changes

Laboratory Testing

• Complete blood count (CBC)
• Comprehensive metabolic panel (CMP) to assess:
  • Electrolyte abnormalities (particularly sodium, potassium, chloride)
  • Kidney function (BUN, creatinine)
  • Acid-base status
• Consider stool culture for Vibrio species (particularly if bloody diarrhea is present)

Management Approach

Immediate Interventions

1. Fluid replacement:

   • If mild-moderate dehydration: Oral rehydration with electrolyte solutions 1
   • If severe dehydration: IV fluids (normal saline or Lactated Ringer's) 2

2. Antiemetic therapy:

   • Metoclopramide 10-20 mg every 6 hours 3
   • Ondansetron 8 mg every 6-8 hours for persistent vomiting 3
   • Consider haloperidol 0.5-2 mg for refractory vomiting 3

Additional Considerations

Foodborne Illness Evaluation

• If symptoms suggest vibriosis (from contaminated oysters):
  • Consider empiric antibiotic therapy if severe symptoms
  • Obtain stool cultures

Electrolyte Management

• Monitor and correct electrolyte imbalances 4
• Pay particular attention to sodium and potassium levels
• Correct at appropriate rates to avoid complications

Special Considerations

When to Escalate Care

• Persistent vomiting despite antiemetics
• Signs of severe dehydration
• Hemodynamic instability
• Severe abdominal pain
• Bloody vomitus or stool

Prevention of Complications

• Ensure adequate hydration with electrolyte-rich fluids 3
• Monitor for signs of electrolyte disturbances
• Gradually reintroduce oral intake with clear liquids once vomiting subsides

Follow-up

• Re-evaluate hydration status and electrolytes after initial treatment
• Consider outpatient follow-up within 24-48 hours if symptoms resolve with initial management
• If symptoms persist beyond 48-72 hours, consider additional diagnostic testing (abdominal imaging, endoscopy)

Remember that raw oyster consumption carries risk of Vibrio infection, which can cause severe illness, particularly in patients with liver disease or immunocompromised states. The primary focus of workup should be on assessing hydration status and electrolyte abnormalities while considering the possibility of foodborne illness.