What are the treatment options for a patient with abdominal pain, low-grade fever, and diarrhea after consuming food from a restaurant, suspected to be food poisoning?

Treatment of Food Poisoning with Abdominal Pain, Low-Grade Fever, and Diarrhea

The primary treatment for suspected food poisoning is oral rehydration therapy, which should be initiated immediately to replace fluid and electrolyte losses. 1

Initial Assessment and Diagnosis

• Food poisoning typically presents with vomiting as the predominant initial symptom within 1-4 hours of consumption, followed by diarrhea 5-10 hours after ingestion 2
• Acute food poisoning typically resolves completely within hours, unlike viral gastroenteritis which may last several days 2
• Perform a thorough clinical evaluation focusing on:
  • Onset of symptoms (sudden onset after eating suggests food poisoning)
  • Stool characteristics (frequency and quantity)
  • Signs of dehydration
  • Travel history
  • Exposure to others with similar symptoms 1

Rehydration Therapy (First-Line Treatment)

• Oral rehydration solution (ORS) should be the primary intervention for mild to moderate dehydration 1
• For adults with normal mental status who can drink adequately, oral rehydration is preferred 1
• Intravenous fluids (lactated Ringer's or normal saline) should be reserved for:
  • Severe dehydration
  • Shock
  • Altered mental status
  • Failure of oral rehydration therapy
  • Presence of ileus 1

Dietary Management

• Resume a normal age-appropriate diet during or immediately after rehydration is completed 1
• Avoid foods that may exacerbate symptoms (spicy, fatty, or dairy products) until symptoms resolve 1

Pharmacological Interventions

Antimotility Agents

• Antimotility drugs like loperamide may be given to immunocompetent adults with acute watery diarrhea after adequate hydration 1, 3
• Loperamide should NOT be used in the following situations:
  • Children under 18 years of age with acute diarrhea 1
  • Patients with bloody diarrhea 1
  • Suspected or proven cases of inflammatory diarrhea or diarrhea with fever 1, 3
  • Patients with suspected Shiga toxin-producing E. coli infection 1

Antiemetics

• Antiemetics (e.g., ondansetron) may be considered to facilitate tolerance of oral rehydration in adults with vomiting 1
• These medications should only be used after adequate hydration is established and should not substitute for fluid and electrolyte therapy 1

Antimicrobial Therapy

• Empiric antimicrobial therapy is generally NOT recommended for most cases of suspected food poisoning 1
• Exceptions where empiric antibiotics might be considered include:
  • Immunocompromised patients with severe illness and bloody diarrhea 1
  • Patients with fever ≥38.5°C and signs of sepsis 1
  • Recent international travel with high fever 1

Probiotics and Supplements

• Probiotic preparations may be offered to reduce symptom severity and duration in immunocompetent adults with infectious diarrhea 1
• Zinc supplementation may be beneficial in children 6 months to 5 years of age with signs of malnutrition 1

Follow-up and Monitoring

• Most cases of food poisoning resolve within 24-48 hours with appropriate hydration 2
• If symptoms persist beyond 48 hours or worsen despite treatment, reevaluation is necessary 1
• Consider noninfectious conditions (lactose intolerance, IBS, IBD) in patients with symptoms lasting 14 days or more 1

Infection Control

• Practice proper hand hygiene after using the toilet, before preparing food, and after handling potentially contaminated items 1
• Food service employees should follow local public health guidance regarding return to work 1

Cautions and Pitfalls

• Avoid antimotility agents in children under 18 years, as they can mask symptoms and potentially worsen outcomes 1, 3
• Do not substitute symptomatic treatment for proper rehydration therapy 1
• Be vigilant for signs of worsening dehydration or systemic infection requiring more aggressive intervention 1