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6.06 Food Poisoning - Staphylococcal


Presentation

The patient is brought to the ED 1 to 6 hours after eating, with severe nausea, vomiting, and abdominal cramps progressing into diarrhea. He appears very ill: pale, diaphoretic, tachycardic, orthostatic, perhaps complaining of paresthesias or feeling as if he is "going to die." Others may have similar symptoms from eating the same food. The physical examination, however, is reassuring. There is minimal abdominal tenderness, localized, if at all, to the epigastrium or to the rectus abdominus muscle (which is strained by the vomiting)

What to do:

What not to do:

Discussion

Many of the symptoms accompanying any gastroenteritis seem to be related to electrolyte disturbances and dehydration, which can be substantial even in the absence of copious vomiting and diarrhea, and resistant to oral rehydration, because the gut is unable to absorb, and allows liter after liter to pool in its lumen. Lactated Ringer's solution is the choice for intravenous rehydration, because it approximates normal serum electrolytes, and can be infused rapidly. Lactated Ringer's approximately replaces the electrolytes lost in diarrhea, but normal saline has more of the chloride lost by vomiting.

The most common food poisoning seen in most EDs is caused by the heat-stable toxin of Staphylococcus, which is introduced into food from infections on handlers, and grows when the food sits warm. Chemical toxins have a similar presentation, but the onset of symptoms may be more immediate. Other bacterial food poisonings usually present with onset of symptoms later than 1-6 hours after eating, less nausea and vomiting, more cramping and diarrhea, and longer courses. A clearly implicated food source may give a clue to the etiology: shellfish suggesting Vibrio parahemolyticus, rice suggesting Bacillus cereus, meat or eggs suggesting Staphylococcus, Campylobacter, Clostridium, Salmonella, Shigella, enteropathic E. Coli, or Yersinia..

Whenever someone suffers any gastrointestinal upset, it is natural, if not instinctive, to implicate the last food eaten. Caution patients (especially if they are planning to sue the food supplier) that the diagnosis of food poisoning cannot be established without a group outbreak or a sample of tainted food for analysis.


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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD