Family Medicine Physician Fails to Order Adequate Follow Up for Vitamin Deficient Patient

I have cared for patients both in the outpatient clinical setting and those who have been hospitalized since 1994 in the US. Nausea and vomiting are arguably the most common side effects to prescription medication and are very common presenting symptoms of illness, including infection, metabolic derangement, intestinal conditions, inter alia. Following any abdominal surgery, gastroenterological (GI) symptoms are extremely common, including bowel irregularity, nausea, vomiting. Persistence of these symptoms beyond 2 days warrants a thorough investigation. I see patients on a regular basis with these issues. Family physicians should order blood tests, routine ones first, including cbc, metabolic tests (electrolytes, calcium, glucose, kidney and liver function) and others depending on medical history and meds being taken. If normal, other tests that would be warranted include magnesium, phosphorus blood tests. Imaging of the abdomen is also considered standard of care, including abdominal series initially, then ultrasound if gallstones are suspected, CT scan of abdomen if cancer or other diseases are suspected, then a GI evaluation. Stool testing is not usually done unless the patient has diarrhea. Altered mental status following any condition/surgery or on its own warrants a neurological evaluation, CT of head, perhaps MRI of head, neurological consultation from a specialist, and depending on history (alcohol excess, drug use, etc.), urine drug screening, vitamin B12, B6 and other B vitamin testing, and serum ammonia.