A 19-year-old woman is brought into the emergency department (ED) complaining of abdominal pain and diarrhea of 3-day duration. She has also been nauseous and has not been able to drink much liquid. Five days ago she returned from a camping trip in New Mexico but did not drink from natural streams. She denies fever but states that she has had some chills. Her stools have been watery, brown, and profuse. The patient denies health problems. On examination, the patient is thin and pale. Her mucous membranes are dry. Her temperature is 37.2°C (99°F), heart rate is 110 beats per minute, and blood pressure is 90/60 mm Hg. The skin has no lesions. Her heart and lung examinations are unremarkable except tachycardia. The abdominal examination reveals hyperactive bowel sounds and no masses. There is diffuse mild tenderness but no guarding or rebound. Rectal examination demonstrates no tenderness or masses and is hemoccult negative. The complete blood count reveals a leukocyte count of 16,000 cells/mm3. The pregnancy test is negative.
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