This case study describes a 35-year-old male patient admitted with gastroenteritis. Laboratory tests revealed elevated white blood cell count and stool culture growth of Staphylococcus aureus and Salmonella enteritidis, confirming bacterial gastroenteritis. The patient was treated with intravenous antibiotics, anticholinergics, antipyretics and probiotics. He showed improvement and was discharged on oral medications including antibiotics, antacids and antiemetics with counseling on diet and hydration.

1. • CASE STUDY BASED ON DISEASE
• {GASTROENTERITIS }
Prepared By
MARTIN SHAJI
PHARM D

2. • Patient name –Mr. x IP no. –6478
• Admission date- 18-1- 19
• Discharge date- 23-1-19
• Age-35
• Sex-m
• Department- Gastroenteronology.
PATIENT DEMOGRAPHY

3. 1. Physical examination: patient was conscious and coherant
Vital signs:
Temperature (oF): 91
Pulse rate (/min): 72beats
Blood Pressure (mm of Hg):110/80mm of Hg
2. Systems Examination:
CVS: S1, S2 +
RS: Clear
GENERAL EXAMINATIONS

4. CHIEF COMPLAINTS;
Loose motions since 3 days ,severe abdominal pain on left progressing all over
the abdomen, along with gastro irritations.
PAST MEDICAL HISTORY
Elevated cholesterol level still 1 year, medications has taken , stopped just
before 3 months.
ALLERGY :(food/drug/other)
No known allergies.
BOWEL AND BLADDER HABIT ;
Irregular with more episodes .
APPETITE;
Normal( on ingestion feeling pain on stomach)
PERSONAL HISTORY AND HABITS:
Diet: Mixed
Sleep: Disturbed.
FAMILY HISTORY:
Nothing significant.

5. PLANNING
1. BLOOD TEST
2. LIPID PROFILE TEST
3. RANDOM BLOOD SUGAR (RBS)
4. STOOL CULTURE
5. ENDOSCOPY
(suggested on 3rd day , followed by colonoscopy).

6. LAB INVESTIGATIONS
• Lipid profile test;
• Total cholesterol:186mg/dl [140-200mg/dl]
• Triglycerides :113mg/dl [60-150mg/dl ]
• High density lipoprotein :28mg/dl [40-75mg/dl ]
• Low density lipoprotein:98mg/dl [50-130mg/dl]
• Very low density lipoprotein:20mg/dl
• RANDOM BLOOD SUGAR- 100mg/dl
[80-140mg/dl]

7. STOOL CULTURE TEST – REPORT
STOOL CULTURE REVEALS THE MICROBIAL DISTRIBUTION AS
FOLLOWS;
108 organism /gram/weight(NORMAL FLORA )
Specific culture media ; Staphylococcus aureus
(103 organism/ gram / weight)
; salmonella entertidis
(101 organism /gram/weight)
On Microscopic examinations ;
APPEARANCE; CLOUDY
MUCUS at lower amounts.
ON CHEMICAL EXAMINATION ;
Nothing abnormal detected

8. • HEAMATOLOGY RESULT NORMAL VALUE
Haemoglobin 12.9gms/dl 12-15gms/dl
Total WBC count 12000cells/cumm 4000-11000cells/cum
Total RBC count 5.27 millions/ cumm 3.8-5.5 millions/cumm
DIFFERENTIAL COUNT
ESR 32mm/hr 0-15mm/hr
ENDOSCOPY
• NOTHING ABNORMAL DETECTED .
COLONOSCOPY
• DESCENDING COLON SHOWS INFLAMMED ,ALONG WITH UNDERLINING CELL
DAMAGE .
• VEGETATIONS SHOWS MINOR AMOUNT (NOT SIGNIFICANT TO REMOVE )
sample has been taken/ test result confirm stool culture.

9. SUBJECTIVE EVALUATION
A 35 years male patient was consulted with the complaints of Loose
motions since 4 days , abdominal pain along with gastro
irritations & fever.
OBJECTIVE EVALUATION
On Examination, the patient was conscious & coherent. Lab data reveals
that the patient having elevated WBC & ESR levels, also stool culture
reveals the presence of mucus & microbes such as Staphylococcus aureus&
salmonella entertidis
ASSESSMENT:
Based on subjective & objective evaluvation the physician
confirmed it as GASTROENTERITIS.( Bacterial induced )
SOAP NOTES

10. CONFIRMATORY
DIAGNOSIS
{GASTROENTERITIS}

11. Sl.N
o.
Drug
Indication
RO
A
Frequency and dose.Brand Name Generic Name
1. INJ.FLAGYL INJ. METRONIDAZOLE ANTIBIOTIC
IV 100ML/500 MG / BID/ FIRST ONE DAY
2. INJ .
DICYCLOMINE
INJ . DICYCLOMINE
HCL
ANTICHOLINERGIC/
ANTIPASMODIC IV 20MG /2ML / TID / 6 DAYS
3. INJ. PARACETAMOL INJ.PARACETAMOL ANTIPYRETIC
IV 300MG/2ML /TID / 6 DAYS
3. INJ . RANTAC INJ . RANITIDINE H-2 blocker/ Antagonist
IV 150MG/5 ML /TID /5 DAYS
4. INJ. CEFIXIME INJ . CEFIXIME ANTIBIOTIC IV
500 MG/5 ML / BID / 5 DAYS
5 T. SPORLAC LACTIC ACID TABLETS PROBIOTIC ORA
L
1 GM / BID / 4 DAYS

12. On the 6 th day vitals such as Temp, Blood pressure, RR are found to be normal ,
along with those frequent episodes of motions and stomach pain also seems to be
decreased , and the patient was conscious and coherent , oral rehydration has been
provided ,
Discharge medication as follows;

13. Sl.
No.
Drug
Indication ROA Frequency and dose.
Brand Name Generic Name
1. T . DICLOSPAS T . DICYCLOMINE(20MG)
+
PARACETAMOL(325MG)
ANTICHOLINERGIC/
ANTIPASMODIC ORAL 20MG+325MG BID / 3 days
2. T . RANTAC T . RANITIDINE ANTI – ULCER
ORAL 150 MG BID/ 5 days
3. T. SALVICA -LB T . CEFIXIME WITH
LACTIC ACID TABLET
ANTIBIOTIC
ORAL
200MG BID/ 5 days
4. T .ONDAN T. ONDANSETRON ANTI-EMETIC /
ANTAGONIST ORAL 4 mg SOS
DISCHARGE MEDICATION

14. PHARMACIST INTERVENTIONS
1.The prescription was rational.
2. No DDI or ADRs were found.

15. REGARDING MEDICATION
1.T. RANTAC ( Ranitidine)
It is an anti ulcerative agent and should be taken twice a day before food.
2. T. CYCLOPAM( Dicyclomine)
It is the drug used for several intestinal problems like intestinal bowel syndromes . It help to
reduce the symptoms to stomach the intestinal cramping , it reduces intestinal muscle spasms
thereby the pain induced over the regions of stomach and intestines. Its an anticholinergic /
antispasmodic drug.
3. T.FLAGYL(Metronidazole)
It is an antibiotic used against certain bacteria and protozoa , used to treat a wide variety of
infections induced by microbes but it wont stand against viruses.
4. T. CEFIXIME & LACTIC ACID TABLET
It is an antibiotic drug used against wide spectrum of bacterial infections.

16. 5. T. ONDAN(Ondansetron)
It is an antiemetic agent used to treat nausea and vomiting caused due
to certain medical conditions. It works by blocking the action of a chemical
substance that causes nausea and vomiting.
6. T.LACTIC ACID BACILLUS
Lactic Acid Bacillus is a probiotic used to treat diarrhea caused due to infections,
antibiotics, etc. It is also used to relieve symptoms of digestive disorders such as
irritable bowel syndrome, inflammatory bowel disease, stomach ulcers, constipation,
indigestion, etc.

17. PATIENT COUNSELING- Instructions for patient
Drink fluids and get plenty of rest. Do not consume alcohol or caffeine. Avoid
medications containing aspirin or ibuprofen, which may irritate your stomach, and do
not take any medications by mouth unless directed by your medical care provider.
1.Drink clear liquids.
Sip water/half-strength sports drinks or suck on ice chips. If you vomit using this
treatment, do not take anything for 1 hour and start over again.
2.If you do not vomit fluids, you may progress to full-strength sports drinks;
popsicles; clear broth; bouillon; decaf tea; clear apple juice; clear, carbonated
beverages without fizz (ginger ale, lemon-lime sodas, etc.). NOTE: To remove the
fizz from soda, pour some into a glass and stir with a spoon.
3.As you become hungry, try moving to soft foods.
Some examples include: saltine crackers, dry white bread/toast, bananas, apple
sauce, plain white rice, soft cereals prepared with water, plain noodles and broth
soups. Do not use sauces or condiments, including butter. You may return to a
normal diet as tolerated within 24 hours after recovery from vomiting.

18. VIRAL GASTROENTERITIS
BACTERIAL GASTROENTERITIS

19. DISCUSSION
Gastroenteritis, also known as infectious diarrhea, is inflammation of the gastrointestinal tract—
the stomach and small intestine. Symptoms may include diarrhea, vomiting and abdominal pain.
Fever, lack of energy and dehydration may also occur