Case discussion

The case:
While celebrating with a group of friends a 58 year old med student managed to consume 6 bottles of beer and 6 shots of hard liquor. Also on the menu that night was clams, grilled fish and oysters some of which were particularly hard to open. The following day he began feeling the typical symptoms of a hang over including headache, nausea, and myalgia. On the 2nd day symptoms persisted. The 3rd day symptoms were accompanied by severe epigastric pain, fever, chills, and an acute bout of diarrhea. The consistency of the stool was noted to be watery with tiny flecks of debris.

Initial diagnosis:
Vibrio spp. infection

The reasoning:
Vibrio is a gram negative rod that is pathogenic to humans. Typically the body's natural defenses, such as the acidity of the gastric fluid are enough to prevent infection. However, the large quantity of carbonated alcoholic beverages consumed during the party may have increased the normal pH level of the gut. Thus, allowing the organism to survive upon consumption. Shellfish such as clams and oysters are known to be natural host of Vibrio spp. and were served in large quantities at the party. Adequate cooking is normally enough to kill the organism. When shellfish are adequately cooked they will typically pop open to expose their meaty flesh. However, as noted many of the oysters where difficult to open indicating that may have been undercooked. Initials symptoms of Vibrio spp. food poisoning may have been masked by alcohol intoxication. However, the symptoms of epigastric pain, fever, chills, and "watery-rice" like diarrhea typical of Vibrio infection still fell within the normal incubation period of 1-3 days.

The reality:
Once I had taken an aerobics class in junior college where we would have to do situps for a period of 45 minutes straight each session. I still remember the how painful my abs felt after that first week and it was... nothing compared to this. This felt like some one grabbed hold of my intestines and was trying to wrench them dry. On top of that I had made a trip to royal throne so many times that I eventually ended up with toilet paper burn.

Lesson learned:
Don't mix beer and oysters, just drink beer.