Gastroenteritis House Call Berlin

Acute gastroenteritis is mostly viral. Norovirus, rotavirus and adenovirus are the most common pathogens in Berlin, followed by bacterial causes such as Campylobacter, Salmonella, Yersinia, and after travel, enterotoxigenic E. coli. Parasitic causes such as Giardia appear in travellers returning from South and Southeast Asia.

Toxin-mediated food poisoning by Staphylococcus aureus or Bacillus cereus shows a very rapid onset, often within hours of the meal, and shorter courses. Pseudomembranous colitis caused by Clostridioides difficile is an important differential after antibiotic therapy.

Not every abdominal pain with diarrhoea is gastroenteritis. Acute appendicitis, diverticulitis, cholecystitis, pancreatitis, ileus, mesenteric ischaemia and gastrointestinal bleeding must be excluded clinically. This triage is the key added value of a specialist house call over telephone advice.

The RAB specialist takes a careful history: onset, frequency and character of stool and vomit, abdominal pain, fever, travel, shared meals, medication, pregnancy and pre-existing conditions. In travellers returning from risk regions we also consider hepatitis A, salmonellosis and cholera-type pictures.

Clinically we examine all four abdominal quadrants, test guarding and rebound, auscultate bowel sounds, evaluate skin turgor and mucous membranes, check blood pressure, pulse and temperature. If gastrointestinal bleeding is suspected we discuss rectal examination.

Rapid tests on site include urine dipstick, blood glucose (especially in insulin-treated diabetics) and, where clinically helpful, a CRP rapid test. For severe dehydration or suspected acute abdomen we organise hospital admission.

The single most important measure in viral gastroenteritis is oral rehydration. We recommend oral rehydration salts from the pharmacy or a homemade mix: one litre of water, four level teaspoons of sugar, half a teaspoon of salt. Tea, broth and still water support the regime; hyperosmolar drinks such as cola or fruit juices should be avoided.

Antiemetics such as ondansetron may allow oral intake despite severe vomiting. Loperamide is considered only in non-febrile, non-bloody traveller's diarrhoea and only on medical advice. Antibiotics are contraindicated in viral gastroenteritis; they help only in specific bacterial cases such as severe salmonellosis in risk patients.

If oral rehydration fails – for example with persistent vomiting – an intravenous infusion at home may be necessary. We decide on the clinical picture and can refer to the Reiche private practice or arrange a hospital admission.

Blood in stool or vomit, persistent high fever above 39 degrees, severe unilateral abdominal pain, rigid abdomen, tendency to collapse or altered consciousness are warning signs that often require hospital evaluation. In pregnant patients we lower the threshold further; a gynaecological emergency department such as Charité Campus Mitte or Vivantes Friedrichshain may be more appropriate.

Infants and small children lose water proportionally faster than adults. Lack of tears, sunken eyes, dry mucous membranes and reduced activity are alarm signs requiring presentation at a Berlin paediatric clinic – DRK Westend, Charité Campus Virchow or Helios Berlin-Buch.

Seniors with chronic disease are also particularly at risk, especially on ACE inhibitors, diuretics or metformin. With clinical signs of acute renal failure or electrolyte derangement we promptly arrange hospital admission.

Gastrointestinal pathogens are highly contagious, particularly norovirus. We recommend home isolation for at least forty-eight hours after the last episode of vomiting or diarrhoea, separate towels, frequent hand washing with soap (alcohol-based disinfectants are less effective against norovirus) and thorough cleaning of bathrooms.

Work in food retail, hospitality, care or childcare is subject to reporting requirements under the German Infection Protection Act. We advise on the rules for return to work and issue corresponding certificates.

Gradual reintroduction of food starts with easily tolerated items: rusks, rice, banana, applesauce, low-fat broth. Dairy is often poorly tolerated for the first few days. If symptoms worsen during this period, please contact +49 30 550 77 870 for follow-up.