A 25-year old female presented with acute gastroenteritis with mild dehydration. She reported vomiting, giddiness, and loose stools. On examination, she had a pulse of 80 bpm and blood pressure of 110/70 mmHg. Laboratory tests showed mild dehydration. She was diagnosed with acute gastroenteritis with mild dehydration and treated with ondansetron, pantoprazole, ciprofloxacin, lactobacillus spores, and metronidazole to suppress bacterial growth and symptoms. Her condition improved over three days.

1. CASE PRESENTATION
ON
ACUTE GASTROENTERITIS
WITH MILD DEHYDRATION
PRESENTED BY,
SAGAR DAS
Reg.no:15Q3406 3RD
pharm.D(2017-18)
Department Of Pharmacy Practice
Mallige College Of Pharmacy, B’lore-90

2. GASTROENTERITIS
 Gastroenteritis (also known as gastro, gastric flu, tummy bug and
stomach flu) is inflammation of the gastrointestinal tract, involving
both the stomach and the small intestine resulting in acute diarrhea.
 The inflammation is caused most often by an infection from certain
viruses or less often by bacteria, their toxins, parasites, or an
adverse reaction to something in the diet or medication.
 Worldwide, inadequate treatment of gastroenteritis kills 5 to 8
million people per year, and is a leading cause of death among
infants and children under 5.
 At least 50% of cases of gastroenteritis due to foodborne illness are
caused by norovirus. Another 20% of cases, and the majority of
severe cases in children, are due to rotavirus. Other significant viral
agents include adenovirus and astrovirus.

3.  Different species of bacteria can cause gastroenteritis,
including Salmonella, Shigella, Staphylococcus, Campylobacter
jejuni, Clostridium, Escherichia coli, Yersinia, and others.
 Some sources of the infection are improperly prepared food,
reheated meat dishes, seafood, dairy, and bakery products.
 Each organism causes slightly different symptoms but all
result in diarrhea.
 Colitis, inflammation of the large intestine, may also be
present Risk factors include consumption of improperly
prepared foods or contaminated water and travel or residence
in areas of poor sanitation.
 It is also common for river swimmers to become infected
during times of rain as a result of contaminated runoff water.

4. SUBJECTIVE EVIDENCE
 Age: 25 yrs. Sex: female
 DOA: 26-07-2017 DOD: 29-07-2017
 Complaints on admission:
 C/o vomiting (10 episodes) since yesterday.
 C/o giddiness
 C/o loose stools (5 episodes) since morning.

5. PERSONAL HISTORY
 PAST MEDICAL HISTORY:- Nothing significant
 MEDICATION HISTORY :- Nothing significant
 SOCIAL HISTORY:-
 Appetite:- DECREASED
 DIET:- Mixed
 Bowel and bladder:- LOOSE STOOLS
 FAMILY HISTORY :- Nothing significant
 OBSTRETIC HISTORY:- Nothing significant

6. OBJECTIVE EVIDENCE
 PHYSICAL EXAMINATION:
 P I C C L E : NEGATIVE
 PR- 80 bpm
 BP-110/70 mmHg
 temp – 96*F
 SYSTEMIC EXAMINATION:
 CVS: S1, S2 normal
 RS : NVBS B/L (+)
 CNS: Conscious and oriented
 PELVIC ABDOMEN(PA): Soft
 PROVISIONAL DIAGNOSIS : gastroenteritis????

7. LAB INVESTIGATION
Biochemical investigation
Test Observed value Reference value
HAEMATOLOGY
Red Blood Corpuscles 4.0 miilion cells/ul (4.2-5.4 million cells/ul.)
White blood corpuscles 10500 /ml (4,500-11,000 cells/ml.)
haemoglobin : 10.9 g/dc (12-15.5 g/dc)
Neutrophills 84% (45-73%)
ESR 09 mm/hr (1-20mm/hr)
Sodium (NA+) 112 mEq/L (136-145)

8. FINAL DIAGNOSIS
 From the subjective and objective evidence, The patient was
diagnosed as:
ACUTE GASTROENTERITIS WITH MILD
DEHYDRATION

9. GOAL OF THERAPY
 Patient specific:
To relive the symptoms of vomiting, giddiness and
loose stools.
 Disease specific:
To eradicate the causative microorganisms responsible
for Gastro Enteritis in this patient.

10. ASSESMENT OF CURRENT THERAPY
Brand name Generic name DOSE ROA FRE Indication TOA
(BF/AF/WF/WW)
Start
date
End
date
Inj.emeset inj.ondensetron 4mg IV 1-1-1 Prevention of nausea and
vomiting
AF 26-07-17 29-07-17
Inj.pantodac Inj. Pantoprazole 40mg IV 1-0-1 It decrease amount of acid
produced in stomach to
protect from erosive stomach
BF 26-07-17 29-07-17
inj.ciprox Inj. ciprofloxacin 100 mg IV 1-0-1 Fluroquinolone antibiotic
which used to suppress or to
kill harmfull bacterial growth
AF 26-07-17 29-07-17
T. sporolac Lactobacillus 120
spores
PO 2-2-2 Anti diarrhec used to
suppress or killinjg harmfull
bacterial growth
WF 26-07-17 29-07-17
Inj. Flagyl 400 Metronidazole 400 mg IV 1-1-1 Antibiotic used to prevent
the growth of certain
bacteria and parasites
AF 26-07-17 29-07-17

11. PROGRESS CHART
DAY1 DAY2 DAY3
B.P
(Mm of Hg)
110/70 120/80 120/90
Pulse
(beats/min )
80 74 72
RR
( cycles/min )
22 20 22
Other
investigation
Loose stools
and giddiness
Vomiting and
giddiness has
reduced
Patient feels
better.

12. PLANNING
DAY 1 DAY 2 DAY 3
PROBLEMS • Bacterial
infection
Rx:
metronidazole
• Diarrhea
Rx :
inj.ciprofloxacin
and
T.Lactobacillus
spores
• Vomiting
Rx: inj. Emeset
Gastric irritation
Rx :
inj. Pantodac
Repeated all Repeated all

13. DISCHARGE MEDICATION
GENERIC
NAME
DOSE
( mg)
FREQUENCY DAYS INDICATION ROUTE TIME
T. flagyl metronidazo
le
400 mg 1-0-1 7 days Anti-bacterial PO After food
T.emeset ondensteron 4 mg 1-1-1 7 days Anti emetic PO After Food
Pantodac pantaprazol
e
40mg 1-0-1 2 weeks PPI PO before food
T.sporlac Lactobacillu
s spores
1-0-0 5 days Anti
diarrhoeac
PO With food

14. PHARMACIST INTERVENTION
 DRUG INTERACTION:- Ciprofloxacin and Ondansetron.
*serious-use alternative.
(Ciprofloxacin and Ondansetron both increase QT INTERVAL. Avoid or use alternative)
 All the other drugs prescribed were screened for adverse drug
reactions and found no adverse drug reactions.

15. TOXICITY PARAMETER
 Metronidazole- seizures; peripheral neuropathy; dizziness; vertigo,
thrombophlebitis; urticaria, erythematous , nausea, anorexia, vomiting, diarrhea,
epigastric distress.
 Pantoprazole- GI tract infection, head ache, myalgia, hyperlipidemia, anxiety,
nausea, abdominal pain.
 Ondensetron- Headache, malaise/fatigue, constipation, drowsiness, fever,
dizziness, anxiety, cold sensation, rash, diarrhea, urinary retention, local injection
site reaction (pain, redness, burning), hypoxia

16. PATIENT COUNSELLING
 DRUG SPECIFIC:
ONDANSERTON:-
 Instruct patient to report signs or symptoms of serious cardiac arrhythmias.
 Advise patient to report hypersensitivity reactions, including anaphylaxis and
bronchospasm .
PANTOPRAZOLE:-
 Take each dose at the same time each day.
 Swallow the tablet whole.
 Avoid alcohol.
 Report any persistent side effects to your doctor.
 Administer 30 minutes before food in order to avoid gastric irritation.
METRONIDAZOLE:-
 Advice the patient to report any hypersensitivity reactions.
 Complete the course of therapy.

17.  DISEASE SPECIFIC:
 Advice the patient to take well cooked food.
 To maintain hygienic condition.
 Increased intake of fluids.
 Don’t take outside foods.
 Advice the patient to avoid spicy foods.
 Avoid infected or contaminated food and water.
 Avoid carbonated beverages.
.

18. THANK YOU