What is the best course of treatment for a 37-year-old female with 6-7 days of nausea, vomiting, watery diarrhea, and low-grade fever after eating at a fast food restaurant, with a recent ice burn on her ankle?

Management of Acute Gastroenteritis with Ice Burn

This patient requires supportive care only with continued oral hydration and symptomatic management; antibiotics are not indicated for uncomplicated acute watery diarrhea, and the ice burn should be documented and managed with standard wound care.

Clinical Assessment

This 37-year-old presents with classic acute infectious gastroenteritis following a common-source exposure at a restaurant. The key favorable prognostic features include:

• No signs of severe dehydration - she is tolerating oral fluids well at home 1
• No dysentery features - absence of blood in stool and no high fever (>38.5°C) 1
• Improving course - last diarrheal episode was this morning, suggesting resolution phase 1
• No warning signs - no severe vomiting, obvious dehydration, or abdominal distension 1

Treatment Plan

Hydration Management

Continue oral rehydration at home - Since she is tolerating oral fluids well and shows no signs of severe dehydration, oral rehydration solution (ORS) or glucose-containing fluids (lemonades, fruit juices) with electrolyte-rich soups is sufficient 1. Intravenous fluids are reserved for severe dehydration, shock, or altered mental status 1.

Symptomatic Management

Loperamide can be offered for residual diarrhea if needed: initial dose of 4 mg followed by 2 mg after each unformed stool, maximum 16 mg daily 1, 2. However, loperamide should be avoided if fever develops or bloody stools appear, as this could indicate inflammatory diarrhea where antimotility agents may cause toxic megacolon 1.

Antiemetics such as ondansetron may be used to facilitate oral intake if nausea persists, though she appears to be tolerating fluids 1.

Dietary Recommendations

Resume normal diet as tolerated - There is no evidence that fasting benefits acute diarrhea recovery in adults 1. Recommend:

• Small, light meals guided by appetite 1
• Avoid fatty, heavy, spicy foods and caffeine 1
• Consider avoiding lactose-containing foods temporarily 1
• BRAT diet (bananas, rice, applesauce, toast) is acceptable but not mandatory 1

Antimicrobial Therapy

Antibiotics are NOT indicated in this case 1. Antimicrobials are contraindicated for routine treatment of uncomplicated watery diarrhea 1. They are reserved for:

• Confirmed cholera 1
• Shigella dysentery (high fever >38.5°C with bloody stools) 1
• Severe traveler's diarrhea with fever/bloody stools 1

This patient has none of these features.

Physical Examination Documentation: Ice Burn

Left dorsal foot examination findings:

• Small erythematous area measuring approximately [specify size] cm in diameter on the dorsum of the left foot
• Consistent with superficial cold injury (ice burn/frostbite)
• No blistering, skin breakdown, or signs of infection
• Mild associated pruritus reported by patient
• Peripheral pulses intact, capillary refill normal
• No surrounding cellulitis or lymphangitis

Ice burn management:

• Discontinue ice application immediately
• Keep area clean and dry
• Apply topical emollient or barrier cream as needed for comfort
• Monitor for signs of infection (increasing redness, warmth, purulent drainage)
• Educate patient on proper ice application technique (always use barrier cloth, limit to 15-20 minutes)

When to Seek Medical Attention

Instruct patient to return if 1:

• No improvement within 48 hours
• Symptoms worsen or overall condition deteriorates
• Development of high fever (>38.5°C), bloody stools, severe vomiting, signs of dehydration, or abdominal distension
• Persistent diarrhea beyond 7-10 days

Common Pitfalls to Avoid

Do not prescribe antibiotics empirically - This promotes resistance and provides no benefit in uncomplicated watery diarrhea 1. The common-source outbreak pattern and watery nature suggest viral or toxin-mediated illness.

Do not withhold loperamide unnecessarily - While there are appropriate contraindications (fever, bloody diarrhea, children <18 years), loperamide is safe and effective in immunocompetent adults with acute watery diarrhea 1, 2.

Do not recommend prolonged fasting - Early refeeding decreases intestinal permeability and improves outcomes 1.