Lahore General Hospital, Lahore Postgraduate Medical Institute, Lahore

LAHORE GENERAL HOSPITAL

GASTROENTERITIS

GASTROENTERITIS/ACUTE WATERY DIARRHOEA STATISTICS
DAILY REPORT 09.09.2014 (8AM TO 8AM)
 
Total No. of Cases of GE/AWD seen and discharged to home Under age 5 yrs Age 5 yrs & above Total
OPD 22 8 30
COD 17 252 269
TOTAL 39 260 299
       
Total No. of New Cases of GE/AWD admitted in the hospital. 0 0 0
Total No. of Old Cases of GE/AWD admitted in the hospital. 0 0 0
GASTROENTERITIS TREATMENT GUIDELINES

Background to condition:

o        Infectious gastroenteritis causes diarrhea with or without vomiting.

o        Cramping abdominal pain.

o        Many cases can be managed effectively with oral rehydration.

o        Enteral rehydration is preferable to intravenous hydration.

o        Shocked patients require urgent resuscitation with 20 mls/kg boluses   

        of  IV Normal Saline.

Assessment:

Is the diagnosis of gastroenteritis correct?:

The following features may occur in gastroenteritis, but should prompt careful consideration of differential diagnoses & review by a senior doctor:

o         Severe abdominal pain or abdominal signs

o         Persistent diarrhea (> 10 days)

o         Blood in stool

o         Looks very unwell

o         Bilious (green) vomit

o        Vomiting without diarrhea

Consider the diagnosis carefully if there is

o        Abdominal pain

o        Isolated Vomiting

Investigations:

In most patients with gastroenteritis no investigations are required

Faecal samples may be collected for microbiological culture if the patient has significant associated abdominal pain or blood in the motions, as a bacterial cause of gastroenteritis is more likely. However these results usually don't alter treatment.

Blood tests (electrolytes, glucose) are not necessary in simple gastroenteritis but are required for:

o          Severe dehydration

o          Comorbidity of renal disease or on diuretics

o          Altered conscious state

o          Ileostomy

Acute Management:

Rehydration

Ondansetron drug dose

o     Should only be administered once in this setting.

Oral rehydration

o      Lemonade, homemade ORS and sports drinks are not appropriate fluids for rehydration

o      Suggest oral rehydration solutions (ORS) eg. Pedialyte

Trial of oral fluids in the emergency department:

o         Note: Most patients with mild/no dehydration can be discharged 

         without a trial of  fluids,  after appropriate advice and follow-up arranged.

o         In patients requiring rehydration: give frequent small amounts of ORS, 

         aiming for 10-20 ml/kg over 1 hour.

o         Significant ongoing GI losses (frequent vomiting or profuse diarrhoea) 

         minimise the chance of success at home. Consider early NGT  

         rehydration in these children.

Intravenous Rehydration

Indications:

o           Indicated for severe dehydration. (eg. ongoing profuse losses or 

          abdominal pain).

o           Also suitable for patients who already have an IV insitu.

IV Fluids see guideline:

o          Initial boluses: 20ml/kg Normal saline boluses, repeated until shock is 

          corrected. If > 40 ml/kg boluses required, involve senior staff and ICU.

o          Measure blood glucose and treat hypoglycaemia with 5ml/kg of 10%  

          dextrose.

o           Measure Na, K and glucose at the outset & at least 24 hourly from

          then on (more frequent testing is indicated for patients with co-

          morbidities or if more unwell). Venous blood gases provide rapid 

          results. It is not necessary to send an electrolyte tube to the lab 

          unless measurement of urea or creatinine is clinically indicated.

o          Consider septic work-up or surgical consult in severely unwell patients

         with gastroenteritis.

o          Ongoing fluids: 5% Dextrose + 0.9% Normal saline (Rates see table). 

          Use a fluid containing KCl (20mmol/L) if serum K < 3mmol/l or give

         oral supplements.

Table 4: Recommended starting rate for IV REHYDRATION AFTER INIITIAL BOLUSES      (0-24 hours)

WEIGHT on
ADMISSION
[kg]

DEGREE OF DEHYDRATION
Moderate or Severe
[mls/hr]

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

30 kg

135

40 kg

165

50 kg

195

60 kg

225

After 1st 24 hours, if needed, use Standard Intravenous Fluids unless abnormal ongoing losses or electrolyte disturbance.

Monitoring of rehydration

o                                   Bare weigh patient 6 hourly in moderate and severe dehydration or iv fluids.

o                                   Careful reassessment after 4-6 hours needs to occur, then 8 hourly to guide ongoing fluid therapy. Look particularly for:

           Wweight change

            Clinical signs of dehydration

            Urine output

            Ongoing losses &

            Signs of fluid overload, such as puffy face and extremities.

Consider transfer when:

o           Severe electrolyte abnormalities

o           Severe dehydration or shock

Discharge requirements:

Medical review before discharge required if:
- < 4% wt gain
- Signs of dehydration or otherwise unwell
- >=3 large stools during rehydration
- Abdominal pain worsening

Anti-diarrhoeals and maxalon are not recommended.Bottom of Form

 

 
Polio Drops Timings
08:00 AM to 01:00 PM (Outdoor)
Friday 08:00 AM to 12:00 AM (Outdoor)
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If someone asks money through Omni or etc services
All these things ar Bogus & Fraud
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WORKSHOP ON NEONATAL RESUSCITATION
with hands on training

Organizing Secretary:
Prof. Dr. Agha Shabbir Ali
Head of Department of Pediatrics
PGMI / AMC / LGH, Lahore.


Time & Date: 11:00 AM TO 1:30 PM
Date: 22-07-2017
Venue: DEPARTMENT OF PAEDIATRICS, LGH, Lahore
Registration:CONTACT/SMS
DR RIZWAN GOHAR
03004204215
rizwangohar@gmail.com

__________________
PGMI / AMC / LGH oganizing its 7th Annual Symposium as decided in last Academic Council meeting.

Organizing Secretary:
Prof. Agha Shabbir Ali
Head of Department of Pediatrics
PGMI / AMC / LGH, Lahore.

Patron & Chairman:
Prof. Ghias un Nabi Tayyab
Principal, PGMI / AMC / LGH, Lahore.

Venue: 5th Floor, PINS, LGH, Lahore
Date:  15th - 16th - March 2017.

__________________
The Administration of LGH has cancelled the MOU
with NTS Authority regarding recuritment of staff

Applications submitted through NTS will not be
entertained.LGH will soon announce the date of
receipt of applications.
__________________
March for Army Public School(Peshwar)
Chief Organizer:
Prof. Khalid Mehmood
Principal PGMI/AMC/LGH
Chief Guest:

Guest of Honour:
Mr. Khawaja Salman Rafique (Advisor to CM on Health)
Date:14th December 2015
Venue:
From PGMI to Shadman Chowk
__________________
Workshop on Lysosomal Storage Diseases (LSDs)
Chief Organizer:
Prof. Agha Shabbir Ali
Head of Pediatrics Department
Venue:
Conference Room Pediatric Ward , LGH, Lahore.

Date:Tuesday, 5th January 2016th,
Time:9:00 AM 12:00
__________________
Walk on World Diabetes Day
Chief Organizer:
Prof. Ghias Un Nabi Tayyab
Prof. of Medicine.
Organising secretary:
Dr. Muhammad Imran Hasan
Associate Prof. of Medicine PGMI/LGH
Organize By:
DEMC/PGMI/LGH, Medical Unit-I, LGH, Lahore.
Chief Guest:
Mr. Sohail Ahmed (Azizi).
Date:14th November 2015
Time:
11:00 AM
Venue:
From LGH Emergency Gate to Stall Area
Last date for registration:
26-10-2015
__________________
Diabetes Education Workshop
Chief Organizer:
Prof. Ghias Un Nabi Tayyab
Prof. of Medicine.
Organising secretary:
Dr. Muhammad Imran Hasan
Associate Prof. of Medicine.
Venue:
Gastro Auditorium, Medical Unit-I, LGH, Lahore.
Date:30th - 31st October 2015
Contact:
0332-2368486
Last date for registration:
26-10-2015
__________________
15th Workshop on Dengue Fever
Chief Organizer:
Prof. Agha Shabbir Ali
Head of Pediatrics Department
Venue:
Conference Room Pediatric Ward , LGH, Lahore.

Date:Saturday, August 29th, 2015
Time:9:00 AM 11:15 AM
__________________
2nd Alumni of PGMI
Venue:
Ali Institute Auditorium, Ferozepur Road, Lahore.
Near Gulab Devi Hospital
Registration (Last Date):Saturday, June 06, 2015
Registration Fee:
Professor Rs.2,000/-
Associate Prof. Rs.1,500/-
Assistant Prof. Rs.1,500/-
Demonstrator/PGR Rs.1,000/-
Date:Wednesday, June 10, 2015
Time:05:00 PM
__________________
2nd THALASSEMIA WORKSHOP
Venue:
Conference Room Pediatric Ward LGH, Lahore.

Date:Thrusday, June 11th, 2015
Time:9:00 AM 02:00 PM
__________________
2nd Workshop on Neonatal Resuscitation
Venue:
Conference Room Pediatric Ward LGH, Lahore.

Date:Saturday, June 13th, 2015
Time:10:00 AM 01:00 PM
Registration Contact:Dr Rizwan gohar Senior registrar
03004204215 email. rizwangohar@gmail.com
Headed By:Prof Agha shabbir ali , Prof Rashid Mehmood
__________________
5th 17th Annual Conference of
Anaesthesiology & Critical Care
Organised by:
Department of Anesthesia, PGMI/AMC/LGH
Supervised by:
Prof. Khalid Bashir,
HOD,Department of Anesthesia, PGMI/AMC/LGH
Venue:
Pearl Continental,Lahore
Date:Friday-Sunday, April 03-05, 2015
__________________
5th Symposium & Live Workshop on Endourology
(PCNL, TVT/TOT, LAPROSCOPIC SURGERY)
Organised by:
Department of Urology, PGMI/AMC/LGH
Supervised by:
Prof. Safdar Ali Shah,
HOD,Department of Urology, PGMI/AMC/LGH
Contact:
0333-8417898
Venue:
Department of Urology, PGMI/AMC/LGH
Date:Monday, February 23, 2015
Time:09:00 AM to 03:00 PM
__________________
5th Annual Scientific Symposium 2015
PGMI/AMC/LGH
Venue:
Neuro Auditorium, LGH, Lahore.
Date:February 18,19 2015
__________________
Fetal Surveillance
(Pre-Conference Workshop)
Antenatal Fetal Surveillance
Intrapartum Fetal Surveillance
NICHD-FHR Classification & Suggested Management
Fetal Surveillance of Surgically Correctable Fetal Anomalies
3rd Trimester Fetal Surveillance by Ultrasound
Organised by:
Department of Obs. & Gynae., PGMI/AMC/LGH
Prof. Nuzhat Khawaja
Prof. of Obs. & Gynae., PGMI/AMC/LGH
Dr. Naela Tarique
Associate Prof. of Obs. & Gynae., PGMI/AMC/LGH
Secretary:
Dr Farzana Latif, Assistant Prof., PGMI/AMC/LGH
Venue:
Neuro Auditorium, LGH, Lahore.
Registration:
Free.
Date:Friday, February 13, 2015
__________________
Basic Knee Arthroscopy Workshop
Organized By:
Department of Orthopaedic Surgery, PGMI/AMC/LGH
Collaboration with:
Pakistan Orthopaedic Association
Venue:
Learning Resource Center
Department of Orthopaedic Surgery, PGMI/AMC/LGH
Registration Fee:Rs. 1000
(Limited seats)
Contact:Mr. Muhammad Akram
0345 4703901
Date:February 11, 2015
__________________
Seminar: Dengue Fever Diagnosis & Management
Organizer:
Prof. Dr. Jawad Zaheer
Prof. of Medicine.
Presenter:
Dr. Kashif Aziz Ahmad
(MD, FCPS)
Venue:
Medical Unit-II, LGH, Lahore.
Date:Monday, January 19, 2015, 10:30 AM
__________________
Award Distribution Cermony
Organized By:
Prof. Irfan Mehboob
Prof. of Orthopaedic.
Venue:
Department of Orthopaedic Surgery, LGH, Lahore.
Date:January 17, 2015
Time:11:30 AM to 12:30 PM
__________________
5thAnnual Scientific Symposium
BLS Workshop
Organised by:
Department of Pediatrics, PGMI/AMC/LGH
Prof. Agha Shabbir Ali
Prof. of Pediatric, PGMI/AMC/LGH
Venue:
Conference Room, Pediatric Department, LGH, Lahore.
Date:Wednesday, January 14, 2015
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