The patient has presented with vomiting, diarrhea, and nausea; moreover, they have a history of drug abuse and are possibly a carrier of Hepatitis C. All of this points to the diagnosis of acute gastroenteritis which causes inflammation and irritation of stomach and intestines. It is possible to contract the illness from contaminated food or via contact with a sick person. The patient takes Prednisone which affects liver functioning and may lead to an increase in Hepatitis C virus levels which would also cause symptoms such as vomiting, diarrhea, and nausea, although additional examination is necessary.
The patient is currently taking Synthroid 100 md for the treatment of hypothyroidism, Nifedipine 30 mg for either high blood pressure or for angina treatment, and Prednisone 10 mg for anti-inflammation. It would be wise to replace Prednisone with a similar drug that does not affect liver function as much and still maintains anti-inflammatory function. Hu and Xie (2019) supply that “currently, the most effective treatment for drug-induced liver injury is to suspend the offending drug(s) and to avoid re-exposure” (p. 122). Dexamethasone in dosage of 5 mg could be used instead, with a single bimodal dose of ondansetron as supporting therapy for vomiting. Wang et al. (2019) state that dexamethasone shows anti-inflammatory and anti-allergic effects. Silverman et al. (2019) supply with examples that single bimodal use of oral ondansetron results in successful treatment of vomiting in acute gastroenteritis.
An example of treatment plan would look as the following: 5 mg of dexamethasone daily as alternative to prednisone, and a single bimodal dose of ondansetron (6 mg and 18 mg orally) to prevent further vomiting. Synthroid can be continued to be taken by the patient, as it does not affect gastroenteritis or immune system function, and has no known interactions with either dexamethasone or ondansetron. However, Nifedipine decreases the effects of ondansetron and increases the levels of dexamethasone, so the patient should monitor closely their condition and ask to modify their angina therapy, if needed.
Thus, overall, Dexamethasone 5 mg should be prescribed as the main anti-inflammation therapy, and ondansetron as anti-vomiting drug. There is no specific treatment for gastroenteritis, however, further examination should be performed to determine the nature of gastroenteritis and the presence of Hepatitis C virus in the patient’s body. Additionally, a hospital stay is advised as the patient is possibly immunocompromised and requires observation at least for two-three days.
References
Hu, P. F., & Xie, W. F. (2019). Corticosteroid therapy in drug‐induced liver injury: Pros and cons. Journal of Digestive Diseases, 20(3), 122–126. Web.
Silverman, R. A., House, S. L., Meltzer, A. C., Hahn, B., Lovato, L. M., Avarello, J., Miller, J. B., Kalfus, I. N., Fathi, R., Raday, G., Plasse, T. F., & Yan, E. C. (2019). Bimodal Release Ondansetron for Acute Gastroenteritis Among Adolescents and Adults: A Randomized Clinical Trial. JAMA Network Open, 2(11), e1914988. Web.
Wang, J., Jiang, W., Li, T., & Ji, G. (2019). Systematic analysis of efficiency and safety of Dexamethasone and Cimetidine in the treatment of gastroenteritis. Academic Journal of Engineering and Technology Science, 2, 184–190. Web.
