What is the management for food poisoning presenting with profuse sweating, vomiting, watery stool, and hypertension?

Management of Food Poisoning with Profuse Sweating, Vomiting, Watery Stool, and Hypertension

This presentation requires immediate aggressive fluid resuscitation as the priority, as profuse sweating combined with vomiting and watery diarrhea creates severe volume depletion that can rapidly progress to hypovolemic shock—the hypertension may paradoxically represent compensatory vasoconstriction in early shock or a specific toxin effect requiring urgent evaluation. 1

Immediate Assessment and Stabilization

Evaluate Hydration Status

• Check for orthostatic vital signs (pulse and blood pressure changes), skin turgor, dry mucous membranes, decreased urine output, and altered mental status 2, 1
• The combination of profuse sweating, vomiting, and watery diarrhea creates massive fluid losses requiring urgent intervention 1
• Assess severity: mild dehydration (3-5% deficit), moderate (6-9%), or severe (≥10% with shock) 2

Critical Warning Signs

• The presence of hypertension with volume depletion is atypical and may indicate:
  • Compensatory response to early hypovolemic shock 2
  • Specific toxin ingestion (certain seafood toxins, mushroom poisoning) requiring poison control consultation 3
  • Severe sympathetic activation from volume loss 2

Rehydration Protocol

For Mild to Moderate Dehydration

• Administer oral rehydration solution (ORS) containing 50-90 mEq/L sodium at 50-100 mL/kg over 2-4 hours 2, 1
• Start with small volumes (5 mL every 1-2 minutes using a spoon or syringe) and gradually increase as tolerated, especially with ongoing vomiting 2, 4
• Replace ongoing losses: 10 mL/kg for each watery stool and 2 mL/kg for each vomiting episode 2
• ORS composition: approximately Na 90 mM, K 20 mM, Cl 80 mM, HCO3 30 mM, and glucose 111 mM 2

For Severe Dehydration or Shock

• Initiate intravenous rehydration immediately with isotonic fluids (normal saline or Ringer's lactate) in 20 mL/kg boluses 2, 1
• Repeat boluses until pulse, perfusion, and mental status normalize 2, 1
• May require two IV lines or alternate access sites (venous cutdown, femoral vein, intraosseous) for severely ill patients 2
• Once stabilized, transition to ORS for remaining fluid deficit 1

Adjunctive Management

Antiemetic Therapy

• Consider ondansetron (0.15-0.2 mg/kg, maximum 4 mg) for persistent vomiting to facilitate oral rehydration 2, 1, 4
• This is particularly useful when vomiting prevents adequate ORS intake 2, 4
• Use caution in patients with cardiac disease due to potential QT prolongation 2

Antimicrobial Considerations

• Antibiotics are NOT routinely indicated for acute watery diarrhea without specific indications 2, 1
• Consider antibiotics only if: high fever present, bloody diarrhea (dysentery), symptoms lasting >5 days, or stool cultures indicate treatable pathogen 2, 1
• Avoid antimotility agents (loperamide) in the setting of profuse watery diarrhea with systemic symptoms, as this may worsen toxin retention 1

Specific Toxin Evaluation

When to Suspect Specific Food Poisoning Syndromes

• The combination of profuse sweating with hypertension suggests possible:
  • Scombroid poisoning (histamine-mediated, causes flushing and tachycardia) 3
  • Ciguatera toxin (can cause paradoxical cardiovascular effects) 3
  • Mushroom poisoning (certain species cause cholinergic symptoms) 3
• Contact poison control center immediately for guidance on specific toxin management and potential antidotes 3, 5

Monitoring and Follow-up

Hospital Admission Criteria

• Severe dehydration not responding to initial oral rehydration 1, 6
• Persistent vomiting preventing adequate fluid intake 2
• Altered mental status or signs of shock 2, 1
• Suspected specific toxin requiring observation for delayed effects 3, 7
• High stool output (>10 mL/kg/hour) 2

Reassessment Points

• Recheck hydration status after 2-4 hours of rehydration therapy 2
• If still dehydrated, re-estimate fluid deficit and continue rehydration 2
• Monitor blood pressure closely—if hypertension persists after adequate rehydration, investigate alternative causes 2

Common Pitfalls to Avoid

• Do not delay fluid resuscitation while pursuing diagnostic workup—rehydration is the priority regardless of etiology 1, 6
• Do not use antimotility agents in this presentation—they can worsen toxin retention and are contraindicated with systemic symptoms 1
• Do not assume hypertension means adequate hydration—it may represent compensatory vasoconstriction in early shock 2
• Do not give antibiotics empirically without specific indications—most food poisoning is self-limited and antibiotics provide no benefit 2, 1
• Do not overlook the need for poison control consultation when presentation includes atypical features like hypertension with volume depletion 3, 5