Epidemiological history and onset of the disease
The disease is closely associated with the alimentary factor. As Anamnesis epidemiologica (epidemiological data) shows, the trigger is often the consumption of questionable food on the way (e.g., purchased during a train trip).
The clinical presentation (Anamnesis morbi) unfolds extremely rapidly:
- Acute onset: nausea and repeated vomiting occur.
- Development of gastroenteritis: profuse watery diarrhea joins within 1.5–2 hours.
- Intoxication syndrome: patients complain of chills, headache, dizziness, and severe generalized weakness.
- Temperature reaction: the initial temperature may be subfebrile (up to 37.5 °C); however, against the background of increasing fluid loss, the condition worsens sharply, and the temperature drops.
Clinical presentation of severe course and complications
With the rapid progression of the disease, especially in elderly patients (e.g., aged 69), the risk of life-threatening complications is high. The main complication is stage II shock (most likely of mixed genesis: toxic and dehydrational).
Physical examination (Status praesens) upon admission to the emergency department reveals:
- General appearance: pronounced pallor, dryness of the skin and visible mucous membranes, decreased tissue turgor. Hypothermia is noted (body temperature drops to 36.4 °C or even 35.6 °C), hands and feet become cold, and pronounced acrocyanosis is characteristic.
- Hemodynamics: severe arterial hypotension (drop in BP to 60/40 or 60/30 mm Hg). Pulse is frequent (up to 120 bpm), of low volume, sometimes arrhythmic. Heart sounds are muffled. The shock index can reach 2.
- Abdominal organs: abdomen is moderately distended, with tenderness or pain in the epigastric region. Palpation reveals borborygmus along the colon. Peritoneal irritation signs are negative, bowel sounds are audible.
- Neuromuscular and urinary systems: the patient is usually conscious but anxious. Lower extremity muscle cramps commonly appear. Anuria develops (bladder is empty upon catheterization).
Laboratory diagnostics
The diagnosis is established based on epidemiological data, the rapid clinical picture of gastroenteritis, and the rapid development of shock symptoms. Strict laboratory monitoring is necessary to accurately determine the degree of dehydration and calculate the volume of emergency anti-shock therapy.
Key parameters to evaluate:
- Patient's body weight (value prior to disease onset).
- Central venous pressure (CVP).
- Hematocrit (Ht).
- Acid-base balance parameters (ABB): blood pH, base deficit, blood gas composition.
- Blood electrolytes: potassium ions (K+), sodium (Na+), chlorides (Cl-).
- Renal function markers (in case of anuria): urea, residual nitrogen.
Intensive care tactics
Treatment of the gastroenteritic variant of severe food poisoning requires immediate multi-component infusion therapy.
First stage — Rehydration The mainstay is the intravenous administration of polyionic solutions. Infusion continues until the body's water and electrolyte losses are fully compensated.
Second stage — Anti-shock therapy If signs of shock persist or worsen despite adequate fluid replacement, it indicates that the infectious-toxic component predominates over the hypovolemic one. In such cases, the administration of the following is indicated:
- Colloidal anti-shock solutions (e.g., dextran / Polyglucin).
- Fresh frozen plasma (FFP).
- Corticosteroid drugs.
Etiotropic therapy The prescription of broad-spectrum antibacterial drugs is not routine, but it is advisable in severe cases of the disease, the presence of pronounced complications, or the threat of generalization of the intestinal infection.
Briefly: answers to topical questions
How exactly (using which formulas) is the volume of solutions for intravenous rehydration calculated?
The total volume of infusion for intravenous rehydration is calculated by summing the initial fluid deficit and ongoing losses.
Specific mathematical formulas are not provided in the materials, but the final volume consists of:
- Compensation of initial deficit — replacement of fluid shortage depending on the degree of dehydration (e.g., loss of 4–6% of body weight).
- Compensation of ongoing pathological losses — replenishment of the volume of stool and vomitus lost by the body after the completion of the first stage of rehydration therapy.
Class and exam questions
On what basis is a diagnosis of bacterial food poisoning established?
The diagnosis is based on a triad: epidemiological data (consumption of questionable food), clinical presentation (rapid gastroenteritis and intoxication), and presence of complications (symptoms of shock, hypotension).
When is it advisable to prescribe etiotropic therapy?
The use of broad-spectrum antibiotics is justified in severe disease courses, the presence of life-threatening complications, and a real threat of intestinal infection generalization.
What does the persistence of shock phenomena after the administration of polyionic solutions indicate?
This indicates that the infectious-toxic component of shock predominates over the hypovolemic (dehydrational) one. In this case, a transition to colloidal solutions, FFP, and corticosteroids is required.
What else to study on this topic
- Differential diagnostic search scope in acute gastroenteritis.
- Features of managing elderly patients with arterial hypotension in infections.
- Principles for calculating the volume of anti-shock infusion therapy based on CVP and body weight.
- Interpretation of acid-base balance (ABB) parameters in severe diarrhea and anuria.
Master the complete topic in the «Infectious Diseases» course
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- Complete guideline on "Prevention of Bacterial Food Poisoning" and 3,312 other subject pages
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- AI tutor answers questions on the topic anytime
- 41 video lessons on the subject
Other topics in the "Acute Intestinal Infections" section
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