A 9-Year-Old Girl Is Brought to the Office Due to Diarrhea

A 9-year-old girl is brought to the office due to diarrhea.  The patient has had 10 episodes of watery diarrhea and abdominal cramping over the past 36 hours.  Her last bowel movement was a few minutes ago in the waiting room bathroom.  She also had an episode of nonbilious emesis prior to the onset of diarrhea, but she has been able to drink water without further vomiting.  The patient says, "I think I am hungry, but I am afraid to eat because I keep having to go to the bathroom.  I am also afraid of throwing up again.  All I ate was a banana and a slice of bread yesterday."  She has been afebrile.  There is no history of recent travel or change in diet.  Several of her classmates have the same symptoms.  The patient has no chronic medical problems and takes no medications; her immunizations are up to date.  Temperature is 37.2 C (99 F) , blood pressure is 112/74 mm Hg, pulse is 108/min, and respirations are 16/min.  Physical examination demonstrates an awake and alert but tired-appearing child.  The lips are slightly dry, oral mucosa is moist, and no erythema or exudate is present in the pharynx.  The neck is supple and there is no lymphadenopathy.  The lungs are clear to auscultation bilaterally, and heart sounds are normal without murmurs.  There is no abdominal distension, and bowel sounds are hyperactive.  The abdomen is soft and nontender without masses or organomegaly.  Which of the following is the most appropriate recommendation for this patient's condition?

A) Clear liquids only, such as apple juice and soup broth, for the next 24 hours
B) Continuance of a bland diet of bananas, rice, applesauce, and toast
C) Hospitalization and intravenous fluids to prevent dehydration
D) Normal, age-appropriate diet with limited sugars, as tolerated
E) Oral antidiarrheal agent to provide immediate relief of symptoms