A woman presents with vomiting and diarrhoea and is unable to tolerate oral fluids. How do you investigate and manage this patient?
Glenda, a 59-year-old retired interior decorator, presents to you, a GP, on a Monday morning, seeking an antiemetic. It is the first time you have met Glenda. She says she developed vomiting and diarrhoea over the weekend, and is unable to tolerate oral fluids. She thinks this may be due to having eaten undercooked chicken while out at Sunday lunch.
On further questioning, she describes several months’ history of lethargy, generalised headaches, abdominal pain, intermittent loose stools and nausea. She has also unintentionally lost 10 kg of weight over the past six months, and now feels dizzy on standing up. Her past medical history includes autoimmune Hashimoto’s thyroiditis treated with thyroxine 150 g daily, but she is otherwise in good health. She takes no other medications and no over-the-counter preparations. Her family history includes a 3-year-old granddaughter who was recently diagnosed with pernicious anaemia and vitamin B12 deficiency.
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