Posters
Presenting Author Academic/Professional Position
Aun Bangash
Academic Level (Author 1)
Medical Student
Discipline/Specialty (Author 1)
Internal Medicine
Academic Level (Author 2)
Medical Student
Discipline/Specialty (Author 2)
Internal Medicine
Academic Level (Author 3)
Medical Student
Discipline/Specialty (Author 3)
Internal Medicine
Academic Level (Author 4)
Resident
Discipline/Specialty (Author 4)
Internal Medicine
Academic Level (Author 5)
Faculty
Discipline/Specialty (Author 5)
Internal Medicine
Discipline Track
Community/Public Health
Abstract Type
Case Report
Abstract
Background: Norovirus is the most common cause of viral gastroenteritis in adults worldwide, yet its vomiting-dominant presentation is often under-recognized, particularly outside outbreak settings. This case is significant due to both the severity of presentation—including starvation ketosis and hypertensive emergency—and the infection control implications within the healthcare environment. Norovirus’s high transmissibility and environmental resilience necessitate heightened clinical awareness, even in isolated cases.
Case Presentation: A 43-year-old male with peripheral arterial disease, uncontrolled hypertension, and alcohol use disorder presented with over 20 episodes of vomiting, right-sided abdominal pain, and shortness of breath. He denied diarrhea and had a known sick contact at work with similar symptoms. The patient also experienced prolonged heat exposure while working outdoors. On admission, he was hypertensive (BP 221/152 mmHg), tachycardic, and afebrile, with diffuse abdominal tenderness but no rebound. Labs showed leukocytosis, creatinine 2.12 mg/dL, ketonuria, and proteinuria. CT imaging revealed pan colonic prominence without obstruction. Supportive management included NPO status, IV hydration, antihypertensive therapy, electrolyte repletion, and CIWA protocol initiation. The patient’s symptoms improved, and he was able to tolerate oral fluids after 48 hours. This clinical picture aligned with norovirus infection, supported by exposure history, vomiting-dominant symptoms, and exclusion of alternative diagnoses.
Conclusions: This case underscores the need to consider norovirus in adult patients presenting with intractable vomiting, even in the absence of diarrhea. Early recognition is critical not only for appropriate medical management but also for infection control. Norovirus is highly contagious and can spread through aerosolized vomitus, contaminated surfaces, and person-to-person contact. Adherence to strict isolation, hand hygiene with soap and water, and hypochlorite-based disinfection is essential to prevent nosocomial spread, especially in healthcare environments.
Presentation Type
Poster
Recommended Citation
Bangash, Aun A.; Martin, Blake C.; Garcia, Stephen M.; Madhere, Gesler; and Campo Maldonado, Jose E., "Norovirus Gastroenteritis Presenting with Intractable Vomiting, Starvation Ketosis, and Hypertensive Emergency: A Case Highlighting Diagnostic and Infection Control Implications" (2025). Research Colloquium. 13.
https://scholarworks.utrgv.edu/colloquium/2025/posters/13
Included in
Norovirus Gastroenteritis Presenting with Intractable Vomiting, Starvation Ketosis, and Hypertensive Emergency: A Case Highlighting Diagnostic and Infection Control Implications
Background: Norovirus is the most common cause of viral gastroenteritis in adults worldwide, yet its vomiting-dominant presentation is often under-recognized, particularly outside outbreak settings. This case is significant due to both the severity of presentation—including starvation ketosis and hypertensive emergency—and the infection control implications within the healthcare environment. Norovirus’s high transmissibility and environmental resilience necessitate heightened clinical awareness, even in isolated cases.
Case Presentation: A 43-year-old male with peripheral arterial disease, uncontrolled hypertension, and alcohol use disorder presented with over 20 episodes of vomiting, right-sided abdominal pain, and shortness of breath. He denied diarrhea and had a known sick contact at work with similar symptoms. The patient also experienced prolonged heat exposure while working outdoors. On admission, he was hypertensive (BP 221/152 mmHg), tachycardic, and afebrile, with diffuse abdominal tenderness but no rebound. Labs showed leukocytosis, creatinine 2.12 mg/dL, ketonuria, and proteinuria. CT imaging revealed pan colonic prominence without obstruction. Supportive management included NPO status, IV hydration, antihypertensive therapy, electrolyte repletion, and CIWA protocol initiation. The patient’s symptoms improved, and he was able to tolerate oral fluids after 48 hours. This clinical picture aligned with norovirus infection, supported by exposure history, vomiting-dominant symptoms, and exclusion of alternative diagnoses.
Conclusions: This case underscores the need to consider norovirus in adult patients presenting with intractable vomiting, even in the absence of diarrhea. Early recognition is critical not only for appropriate medical management but also for infection control. Norovirus is highly contagious and can spread through aerosolized vomitus, contaminated surfaces, and person-to-person contact. Adherence to strict isolation, hand hygiene with soap and water, and hypochlorite-based disinfection is essential to prevent nosocomial spread, especially in healthcare environments.
