What could be the cause of this patient’s apparent ‘gastric flu’ symptoms?

Case of the month: In the next in our series, Dr Andy Eaton asks what else might be going on in this mid-40s male patient presenting with fever, vomiting and diarrhoea following a bout of ‘gastric flu’ in his household. Post your answers below!

Details of the case have been changed to ensure patient anonymity

The case concerns a 45-year-old male patient, a musician who is usually fit and well. His wife contacts the practice on his behalf and asks for a same-day telephone consultation, saying he is ‘really poorly with gastric flu’.

You phone and speak to the patient, as his wife has had to leave the house for an hour. He tells you that he has been unwell for 6-7 days with a bit of an upset stomach. He apologises for wasting your time because he feels his wife just got a bit panicky as his diarrhoea just seemed to be getting worse, and his temperature wouldn’t settle.

There is no recent history of any foreign travel, or any previous operations, and he is on no regular medication. He doesn’t smoke, and enjoys a few drinks after one of his gigs but never to excess.

He tells you he is managing to take some sips of water and has had half a slice of dry toast for breakfast, but he has vomited 4 times already today, and continues to have frequent, watery diarrhoea. His 8-year-old twin daughters have both had a viral sickness bug but are on the mend now, so thinks he just needs a few more days to persevere with fluids and paracetamol to get it all out of his system. He asks if an anti-emetic may help in the meantime?

However, you are worried, because the message from his wife mentions that he was unsteady on his feet and a bit muddled. The patient denies this and says that he just got up too quickly, and wobbled a bit rushing to the toilet earlier because he thought he was going to be sick. He admits he was a bit dazed when she left the house first thing today as he had just woken up, but he says he feels fine now.

You think through the various options here, which include:

Giving him the anti-emetic with careful safety netting advice.
Offering him a face-to-face assessment (but you really don’t want him to vomit all over your surgery).
Sending him direct to hospital, although you can’t help thinking he sounds quite well on the phone.

What course of action should you take? Is there further information that might help you to make the most appropriate decision? Share your ideas in the comments box below. Answer to be revealed soon!

Dr Andy Eaton is a GP and GP educator in Somerset