MRCP2-2900

MRCP2-2900

A 25-year-old man returns home with diarrhoea, having worked on a volunteer project in South America. He also complains of abdominal bloating, that his stools are difficult to flush away and of excessive flatulence. He has lost his appetite over the past few weeks and has lost 4 kg in weight.

On examination, he has mild pyrexia (37.5 °C) and looks bloated. Investigations reveal the following:

Haemoglobin (Hb) – 130 g/l (normal value: 130-170 g/l)
White cell count (WCC) – 8.5 × 109/l (normal value: 4.0–11.0 × 109/l)
Platelets (PLT) – 280 × 109/l (normal value: 150–400 × 109/l)
Sodium (Na+) – 142 mmol/l (normal value: 135–145 mmol/l)
Potassium (K+) – 4.6 mmol/l (normal value: 3.5–5.0 mmol/l)
Creatinine (Cr) – 95 μmol/l (normal value: 50–120 µmol/l)
Albumin – 42 g/l (normal value: 35–55 g/l)
Stool sample – No cysts or ovae seen

What is the most appropriate treatment for him?