renal failure case presentation
TRANSCRIPT
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PHARMACOTHERAPEUTICS
CASE PRESENTATION
RAJNANDINI SINGHA
III PHARM D
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CASE STUDY
ON
CHRONIC RENAL
PARENCHYMAL DISEASE
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SUBJECTIVE
A 65 year old Male patient was
admitted in PMCH on 13/7/2017
with the complaints of
abdominal pain for 10 days.
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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.
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PAST HISTORY
Diabetes mellitus for past 20 yrs.
Hypertension for past 25 yrs.
Taking medication such as STATINS
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PERSONAL HISTORY
Diet: Mixed.Alcohol for past 40 yrs.
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GENERAL EXAMINATION
Patient conscious, orientedBP :160/70 mmHgPR :79 bpm
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SYSTEMIC EXAMINATION
CVS – S1S2 HeardRS - B/L AE+CNS – NFNDP/A - Soft
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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
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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 +
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OTHER INVESTIGATION
ECG- sinus rhythm inferior myocardial infraction.
X-RAY –Left lung lower lobe consolidations , Bilateral infiltrates .
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USG ABDOMEN & PELVIS:
B/L Chronic renal parenchymal diseases.
B/L Small renal cortical cyst.
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Myocardial infraction
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Left lower lung consolidation
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Bilateral infiltrates
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Renal cortical cyst
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ASSESMENTFINAL DIAGNOSIS
Chronic Renal parenchymal disease.
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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 √ √ √ √ √
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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 √ √ √ √ √
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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
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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
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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.
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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.
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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.
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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.
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THANK YOU