A 56-year-old with diarrhea and weakness

Abstract

A 56-YEAR-OLD MAN presents to the emergency department with nausea, weakness, and exertional dyspnea, which have been going on for 1 week. He is sent by his primary care physician after being noted to be hypotensive with a weak, thready pulse. He has had diarrhea with intermittent abdominal pain over the past year, with 10 stools daily, including 3 or 4 at night. The stools are described as large, nonbloody, sticky, greasy, and occasionally watery. Stools are fewer when he curtails his food intake. The diarrhea is associated with occasional diffuse abdominal pain he describes as a burning sensation. He has no incontinence or tenesmus. He reports that he has unintentionally lost 137 lb (62 kg) over the past year. He has not taken over-the-counter antidiarrheal agents.