PHARMACOTHERAPEUTICS

CASE PRESENTATION

RAJNANDINI SINGHA

III PHARM D

CASE STUDY

ON

CHRONIC RENAL

PARENCHYMAL DISEASE

SUBJECTIVE

A 65 year old Male patient was

admitted in PMCH on 13/7/2017

with the complaints of

abdominal pain for 10 days.

HISTORY OF PRESENT

ILLNESS

H/O Abdominal pain, pricking type,

more during at night.

H/O swelling, Difficulty in breathing

H/O Abnormal urine colour , Frequent

urination at night.

H/O LOA, LOW , Fatigue, fever

No H/O Abdominal distension.

H/O Muscle cramp.

PAST HISTORY

Diabetes mellitus for past 20 yrs.

Hypertension for past 25 yrs.

Taking medication such as STATINS

PERSONAL HISTORY

Diet: Mixed.Alcohol for past 40 yrs.

GENERAL EXAMINATION

Patient conscious, orientedBP :160/70 mmHgPR :79 bpm

SYSTEMIC EXAMINATION

CVS – S1S2 HeardRS - B/L AE+CNS – NFNDP/A - Soft

OBJECTIVEINVESTIGATION CHART

NAME OF INVESTIGATION

OBSERVED VALUE NORMAL VALUE

WBC 6.2x109/L 4.5-10.5×109/L

RBC 4.26x1012/L 3.8-5.9×1012/L

HAEMOGLOBIN 9.5g/dl 12-14g/dl

PLATELETS 173.0109/L 130-400109/L

L/M/G 2.5/1.5/11.0109/L

MCV 92.9 FL 80-100FL

HCT 23.2% 35-50%

MCH 27.6pg 27- 34pg

MCHC 29.7g/dl 32-36g/dl

ESR 38mm/hr 0-20mm/hr

BIOCHEMISTRY

RBS 67 mg/dl Up to 140 mg/dl

BLOOD UREA 46 mg/dl 10-40 mg/dl

SERUM CREATININE 2.2mg/dl 0.6-1.3 mg/dl

GFR 14ml/min

SERUM PHOSPHATE 7.5 mg/dl 2.5-4.5 mg/dl

URINE ANALYSIS

COLOUR Brown

REACTION Acidic

ALBUMIN +

OTHER INVESTIGATION

ECG- sinus rhythm inferior myocardial infraction.

X-RAY –Left lung lower lobe consolidations , Bilateral infiltrates .

USG ABDOMEN & PELVIS:

B/L Chronic renal parenchymal diseases.

B/L Small renal cortical cyst.

Myocardial infraction

Left lower lung consolidation

Bilateral infiltrates

Renal cortical cyst

ASSESMENTFINAL DIAGNOSIS

Chronic Renal parenchymal disease.

DRUG CHARTDRUG GENERIC

NAMEDOSE ROUT

EFREQ 3 4 5 6 7

Inj.taxim cefotaxime 2gm IV bd √ √ √ √ √

T.RANTAC Ranitidine 150mg

oral od √ √ √ √ √

T.BCT Vitamin B+ Vitamin C

Oral bd √ √ √ √ √

T. Dolo Paracetamol 650mg

oral bd √ √ √ √ √

Inj. Deri Theophylline+Etophylline

20mg IV bd √ √ √ √ √

T.LASIX FUROSEMIDE 40mg oral bd √ √ √ √ √

inj . Procrit Erythropoietin 100mg

IV od √ √ √

T.Cozar Losartan 50mg oral od √ √ √ √ √

DRUG GENERIC NAME

DOSE ROUTE

FREQ 3 4 5 6 7

T.calciumcarbonate

Calciumcarbonate

2gm oral Od √ √ √ √ √

T.Hamengeol Propranolol 40mg oral Od √ √ √ √ √

T.Januvia sitagliptin 100mg oral Od √ √ √ √ √

T. Flovas Pitavastatin 2mg oral Od √ √ √ √ √

DISCHARGE SUMMARYThe patient was discharged on 8/07/17

DISCHARGE ADVICE

T . Lasix ODT . Rantac ODT.DERI 150 mg 1-0-1 (10)T.Losartan ODT.Calcium carbonate ODT.BCT BDT . Sitagliptin od T. Pitavastatin od Review after 1 week

PLAN

DISEASE BASED COUNSELLING

Blood purification must be done once to remove the metabolic waste and toxins. Such as:DialysisBlood perfusion plasma exchange

Hypertension:

BP should be controlled.Low intakes of salt

DIABETES MELLITUS:Control sugar levels.Obesity can progress to CKD

Renal cortical cyst:

Avoiding spicy foods, salted, leftovers, polluted foods, greasy foods, stimulating foods as chocolates, coffee, crabs, etc.

Avoid smoking , drinking alcohol. Nicotine and alcohol can accelerate the growth of cysts, elevate your blood pressure and worsen damages on the kidneys.

Diet based counseling

Low protein diet, Low Salt Diet ,Limited intake of potassium (milk or milk products, honeydew, legumes, nuts, potatoes, seeds, tomato products and yogurt.)

Limited intake of phosphorous(meats, whole grain breads, cola beverages, cheese, dried beans , peanut butter, dairy products and chocolate).

Avoiding unhealthy fats.

DRUG BASED COUNSELLING

Ranitidine should be administered 30

minutes before consuming food

Furosemide should be administered 1 hr before

consuming food or 2 hrs after food.

Calcium carbonate should be taken 5 mins

before the food as it causes faster absorbtion of

calicium carbonate.

PHARMACIST INTERVENTIONThe patient has very low RBS So the diabetic profile should be monitored again and the drug dose should be adjusted.

Beta blockers are sometime contraindicated in patient having difficulties in breathing, so it can be switch to other classes of drugs such as ACE INHIBITORS and ARB drugs.

THANK YOU