CASE STUDY ON ACUTE

GASTROENTERITIS
A 45 year old female patient was admitted in hospital with

CHIEF COMPLAINTS
C/O Fever – since yesterday; continuously associated with
chills and rigor
C/O Myalgia
C/O Giddiness ; Headache (+)
C/O Loose stools & Vomiting- 4 times/day ; Abdominal pain-
1 day

HISTORY OF PRESENT ILLNESS

H/O Abdominal pain (+)
H/O Vomiting & Nausea (+)
H/O Generalized body pain (+)
H/O Dysuria ; Cold & Cough
PAST MEDICAL HISTORY:
K/C/O Hypertension X 3 months on regular treatment

PAST MEDICATION HISTORY:

HTN  T. Amlodipine 2.5 mg BD X 3 months

PERSONAL HISTORY AND HABITS:

Mixed diet
No allergies

MENSTRUAL HISTORY :
P2L2; LCB – 24 years back
Attained menopause 2 years ago.
GENERAL EXAMINATION:
Pulse: 86/min RR: 24 cycles/min
Temperature :
TEMP 10/7 11/7 12/7 13/7 14/

102 F 99 F Afebrile Afebrile Afebrile

SYSTEMS EXAMINATION :
CVS : S1S2 (+) R.S : NVBS CNS : NFND
ABD : Soft

BP 10/7 11/7 12/7 13/7 14/7 15/7 16/7 17/7 18/7 19/7 20/7
130/ 120/ 130/ 130/ 130/ 160/ 120/ 130/ 120/ 130/ 130/
90 80 90 80 80 90 90 80 80 90 80
LAB INVESTIGATION REPORT:
PARAMETER VALUE NORMAL RANGE
Hemoglobin 12.2 g/dl 14-18 g/dl
DC P61L34 E5 P40-80 L20-40 E1-6 (%)
TC 9600 cells/cu.mm 4000-11000 cells/cu.mm

ESR <4mm-10mm/hr 1-20mm/hr

PT 12.8 ; 1.05  
RBS 109 mg/dl 79-140mg/dL
BUN 21 7-25mg/dL
Creatinine 0.6mg/dl 0.6-1.3 mg/dl
  ALT 34 7- 48 U/L

 LIVER AST 17 8- 56 U/L

PROFILE ALBUMIN 3.2 3.5 – 5.5 mg / dl

  ALK PHOS 68 56 – 112 U/L

T.PROTEIN 6.8 6-8

T. Cholesterol 204 <200

Urine Acetone Negative  
Urine albumin NIL  
Urine sugar NIL  
OTHER INVESTIGATIONS :
• ECG
• USG Abdomen

IMPRESSION :
• USG (ABD & PELVIS) – Mild fatty liver
Multiple fibroids in the anterior wall of uterus.
• ECG- Normal study
 DIAGNOSIS:
ACUTE GASTROENTERITIS
DRUG CHART:

DRUGS PRESCRIBED DOSE ROA FREQ DURATION

IVF.RL 1o IV Over 4 hrs 10/7 – 13/7

IVF. DNS 1o IV SOS 10/7 – 13/7

Inj. Cefotaxime 1g IV BD 10/7 – 14/7

Inj. Pantoprazole 1 amp IV OD 10/7 – 11/7

Inj. Ondansetron 2 cc IV BD 10/7 – 11/7

Inj. Paracetamol 2cc IM BD 10/7

T. Paracetamol 500 mg P/O TDS 10/7 – 11/7

T. Pantoprazole + 40mg + 30 P/O 1-0-1 10/7 – 19/7

Domperidone mg

T. MVT/BCT 1 P/O OD 10/7 – 19/7

 Cough syrup 1 tsp P/O HS 10/7 – 11/7

T. Metronidazole 500 mg P/O 2-2-2 10/7 – 14/7

T. Norfloxacin 400 mg P/O 1-0-1 10/7 – 12/7

T. Otilinium bromide 40 mg P/O 1-1-1 10/7 – 12/7

Inj. Ranitidine 2 cc IV BD 12/7 – 15/7

Lactobacillus 1 P/O 1-1-1 10/7 – 12/7

Inj. Dicyclomine 2cc IM STAT 10/7 – 12/7

SOS 15/7 – 16/7

T. Amlodipine 2.5 mg P/O BD 10/7 – 19/9

T. Alprazolam 0.5 mg P/O HS 10/7 – 14/7

Syp. Gelusil 10 ml P/O TDS 10/9- 15/9

Adverse Drug effects:
No potent Adverse effects were found
Drug interaction:
No potent Drug interaction were found
Discharge advise:
• C. Omez 20mg 1-0-1
• T. Domstal 10mg 1-0-1 SOS
• T. Amlodipine 2.5 mg 1-0-1
• C. Bifilac 1 tab
 CRITICAL EVALUATION OF PRESCRIPTION:
For HYPERTENSION :
As per JNC guidelines,
• The JNC-8 calls for treatment to lower blood pressure (BP) to 150/90 mm
Hg in those age 60 and older, and to 140/90 for adults less than 60. In the
population age 18 and older with diabetes, the guidelines recommends
initiating drug treatment to a goal of systolic BP<140mmHg, and a
diastolic goals of <90mmHg.
• In adults with CKD, initial (or add-on) antihypertensive treatment should
include an ACEI or ARB to improve kidney outcomes.
• In the general population, including those with diabetes, the initial
antihypertensive treatment should include either a thiazide, calcium
channel blocker (CCB), angiotensin-converting enzyme inhibitor (ACEI),
or angiotensin receptor blocker (ARB).
• This applies to all CKD patients with hypertension regardless of race or
diabetes status.
FOR ACUTE GASTROENTERITIS :
As per NICE guidelines,
• Oral Rehydration Therapies should be given.
• Antimicrobial therapy should be initiated with the use of
metronidazole at 10mg/kg.
• Symptomatic relief can be given with the use of antiemetics such as
ondansetron 4mg or Domperidone 10mg
• Antibiotics belonging to the class of Penicillins and cephalosporins
are to be given unless known allergies. In case of allergies, the
selection has to be rationalized.
• Pre/Probiotics should be given to prevent further damage to the
internal flora.
PATIENT COUNSELLING:-
REGARDING DISEASE:-
Hypertension (HTN or HT), also known as high blood pressure (HBP),
is a long- term medical condition in which the blood pressure in
the arteries is persistently elevated.
Gastroenteritis is an infection of the gut (intestines). It causes diarrhoea
and may also cause symptoms such as being sick (vomiting) and
tummy (abdominal) pain.
REGARDING DRUGS:
• T. AMLODIPINE – It is an anti-hypertensive drug given twice
daily.
• T. DOMPERIDONE:- It is an antiemetic drug and should be taken
twice a day when ever necessary.
• C.BIFILAC:- It is a probiotic drug and should be taken once a day.
• C.OMEPRAZOLE:- It is PPI and given twice daily.
REGARDING LIFE STYLE MODIFICATIONS:

• Food should be taken at right time.

• Strictly adhere to the drug regimen prescribed and regular exercise
to be practiced .
• The patient was advised to have less of salt.
• Avoid fried and oily food items, fast food etc.
• Take plenty of fluids. The aim is to prevent dehydration. The fluid
lost in their vomit and/or diarrhea needs to be replaced.
• The patient was asked not to Stress herself.
• The patient was asked to take fruits (not citrus), vegetables, low-fat
dairy products, beans, whole-grain breads, and lean meats and fish.
• Try to eat small meals, and drink water with your meals.
• Do not eat for at least 3 hours before you go to bed.  
• The patient was asked to put down fat rich foods
THANK YOU