Doctor for gastroenteritis in Berlin — house call sensible?

How we manage gastroenteritis at home

Acute gastroenteritis is one of the most common house-call indications — and one of the pictures where practice visits are particularly unbearable, because vomiting, frequent stool urgency and the need for an immediately reachable bathroom are incompatible with a waiting room. We come to you, take a history (duration, frequency of stool and vomiting, travel history, shared meals with other affected, comorbidities), examine the abdomen for bowel sounds, tenderness, localisation, check circulatory stability (BP lying and standing — orthostasis is an early dehydration sign), pulse oximetry, blood glucose if needed, and assess mucous-membrane dryness and skin turgor. If a bacterial course is suspected (blood or mucus in stool, high fever, travel to risk regions), a stool sample can be sensible.

Therapy is symptomatic in the vast majority: enough fluids with electrolytes (oral rehydration solution, alternatively water with salt and sugar in a 1:1 ratio plus cola), small frequent sips instead of large amounts at once, light food during recovery (rusks, peeled banana, rice, clear broth), avoidance of dairy and fat for 24 to 48 hours. For severe vomiting we administer an antiemetic on site — dimenhydrinate, in adults metoclopramide, in selected cases ondansetron. Loperamide (Imodium) is allowed for pure viral gastroenteritis but contraindicated in bloody diarrhoea or suspected bacterial cause because it impairs pathogen elimination. Antibiotics are indicated only for proven or strongly suspected bacterial courses — most gastroenteritis cases are viral and self-limiting.

When hospital is needed: untameable vomiting beyond 12 hours despite antiemetic, signs of severe dehydration (marked skin turgor, sunken eyes, tachycardia over 110, falling BP, confusion), bloody diarrhoea with fever and poor general state (suspected enterohaemorrhagic pathogens), strongly reduced urine output, very small children and very old patients with dehydration signs. These pictures require intravenous rehydration which is a hospital service — we organise admission and call the A&E.

Example: family with norovirus on a weekend

A family of four in Steglitz catches a gastroenteritis over the weekend — mother and both children have been vomiting since the night, father has diarrhoea. They call on Sunday morning. We come at lunchtime and assess all four: no severe dehydration, children still drinking small amounts, mother orthostatically unstable. We give an antiemetic to mother and one child, define a fluid plan for the next 24 hours, hand over the classic ORS approach and escalation triggers. Stool sample of the mother for clarification — norovirus expected, confirmed two days later. Phone follow-up Monday evening: stabilised, no hospital needed.

What happens during a gastroenteritis house call

• History: duration, frequency, consistency, accompanying symptoms, travel, contacts.
• Examination: abdomen, bowel sounds, tenderness, orthostasis, mucous membranes, skin turgor.
• Antiemetic on site: dimenhydrinate or metoclopramide, ondansetron in selected cases.
• Rehydration plan: volumes, frequency, electrolyte composition — discussed precisely.
• Stool sample for suspected bacterial cause: norovirus, rotavirus, campylobacter, salmonella.
• Loperamide in viral gastroenteritis: allowed; in bloody diarrhoea: contraindicated.
• Hospital escalation for: untameable vomiting, severe dehydration, bloody stool with poor state.