Course 6, case 15
revised 2009
Kas 6-15E: A patient with diarrhoea
50- year-old woman A.B, shopkeeper. She has never been seriously ill. Now she is suffering
from watery diarrhoea lasting for 4 days.
Family history: mother – hypertension, died at 75 because of stroke
father is still alive, 80 years old, he has diabetes since his 62,
1 sister and two children are healthy
Personal history: common children´s ailments, she has no chronic disease, she uses only
hormonal substitution therapy. No operations, no transfusions, no allergy, social conditions
are good. She smokes 5 cigarettes per day.
Present illness: She had urethrocystitis with dysuria and fever 2 weeks ago. The practitioner
gave her chinolon therapy (norfloxacin).The therapy was finished 5 days ago. The second day
after finishing the therapy the diarrhoea started, she has 6-8 watery stools per day, including
night, without "belly ache", without vomiting, without fever, there was no mucus or blood in
the stool, only the day before today there was small stain of blood on the toilet paper.
Epidemiological history: she thinks she made no diet mistake, she eats rational diet, she had
no fast food, no eggs, no chicken. No other members of family suffer from such problems.
Physical examination: She is conscious, completely oriented, without fever, normosthenic,
lowered cutaneous turgor, dry tongue, blood pressure 110/60, pulse 90 beats/min, no
arrhythmias, no murmurs, soft abdomen, painless, without resistance, without hepato- and
splenomegaly, legs without oedemas.
Laboratory findings: blood count – normal, ESR 15/20, osmolarity 305 mosmol/l,
K 3.2 mmol/l, Na 130 mmol/l, Cl 95 mmol/l, AST, ALT, GMT, ALP and bilirubin – normal,
proteinaemia and albuminaemia – normal, urine – normal.
Questions and tasks:
1. What type of diarrhoea is it?
2. What etiology of the diarrhoea do you suppose?
3. Why has she hypokalemia?
4. Evaluate serum osmolality
5. What diagnostic procedures do you suggest?
6. How will you treat the patient?
7. What is the prognosis of this illness?
8. Infectious enteritis and colitis