A 23-year-old female presents with 24 hours of watery diarrhea and vomiting after a cruise. Which management is most appropriate at this time?

• A. Loperamide (Imodium)
• B. IV hydration
• C. Bismuth Sulfate (Pepto Bismol)
• D. Ciprofloxacin (Cipro)

Answer: (B)

Dehydration prevention and correction is the priority in acute gastroenteritis. After 24 hours of vomiting and watery stools, oral intake may be insufficient, risking hypovolemia; IV hydration is the best initial management to restore volume and electrolyte balance. Anti-diarrheal therapy isn’t the primary step here because an infectious process is likely, and slowing gut movement can hinder clearance and worsen symptoms in some infections. Bismuth subsalicylate offers only symptomatic relief and won’t fix the dehydration. Antibiotics like ciprofloxacin are not indicated for uncomplicated viral gastroenteritis and aren’t warranted until a specific bacterial infection is identified or in severe cases. After fluids, reassess tolerance for oral rehydration and use antiemetics as needed.