A case study on acute pancreatitis

Pancreatitis is the Inflammation of the pancreatic parenchyma. Acute condition of diffuse pancreatic inflammation & auto digestion, presents with abdominal pain, and is usually associated with raised pancreatic enzyme levels in the blood &urine. this is a case study on acute pancreatitis describing factors such as patient demographic data , pharmacist intervention , pathophysiology , treatment , prevention , imaging techniques , diagnosis , lab investigation etc

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1. CASE STUDY ON ACUT E PANCREATITIS PRESENTED BY MARTIN SHAJI PHARM D

2. PATIENT DEMOGRAPHIC DATA : Name pra santh Age : 49 years Gender: Male Weight : 68 kgs IP no : 5637 Department / Ward : General male medicine Date of admission : 1 - 9 - 2018 Date of discharge : 5 - 9 - 2018

3. CHIEF COMPLAINTS : - Abdominal pain since 4 days, Vomitings since 2 days with 3 episodes, Fever since 2 days, Abdominal discomfort, Nausea. Loss of appetite

4. PAST MEDICAL HISTORY : Known Hypertensive since 5 years Past Medication History : Anti Hypertensive Therapy since 5 years SOCIAL HISTORY : Alcoholic since 10 years.

5. ON EXAMINATION : Patient is conscious coherent and vital signs are as follows : S. No Vital signs Days 1 2 3 4 1 Temperature(degrees F) 102 101 99 99 2 Blood Pressure(mm of Hg) 130/90 130/90 120/90 120/90 3 Pulse Rate(bpm) 90 89 89 87

6. LABORATORY INVESTIGATIONS : S.No Parameter Observed range Normal value 1 Hemoglobin 10 gm /dl 11-16.5 gm /dl 2 RBC 4.2 Cell/cum 3.80-5.80 cells/ cum 3 Total count 8000 cells/cum 3500-10000/ cum 4 Serum C r e a ti n i n e 1.9 mg/dl 0.6-1.1 mg/dl 5 Bilirubin 1.4 mg/dl 0.5-1.1 mg/dl CT Scan – In CT scan report , damaged tissue was observed in pancreas.

7. DIAGNOSIS : Based on the symptoms , signs and laboratory reports the case was diagnosed as ACUTE PANCREATITIS.

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9. PLANNING: - • • C o n t i n u e t h e s a m e t r e a t m e n t a s suggested by the physician Time interval should be maintained while taking Pantop and Iron supplements Avoid taking Diclo and Atenolol together to overcome drug interaction. Blood pressure levels should be monitored regularly.

10. The treatment was started by following medications On day 1 : T.pct is given 500mg once daily,I.pantop is given 40 mg iv ,i.metrogyl is given 500mg iv twice daily,T.aten is given 50mg once daily,T.emecet 8mg is given twice daily,T.diclo 50mg is given once daily,T.b complex is given once daily,T.IFA 100mg is given once daily On day2,3 : Symptoms are not reduced ,same treatment was continued

11. On day 4: Symptoms were reduced , patient counselling was done and was discharged with some of the medications.

12. DRUG CHAT:- S. No Generic name B r a n d name Frequency Dose ROA Duration of treatment 1 2 3 4 1 T.Paracetamol Colpol O D 500 mg Oral     2 Inj.Pantoprazole Pantop B D 40 mg IV     3 Inj.Metronidazole Metrogyl B D 500 mg IV     4 T.Atenolol Aten O D 50 mg Oral     5 T.Ondansetron Emecet B D 8 mg Oral    6 T.Diclofenac Diclo O D 50 mg Oral    7 T.B-Complex O D 50 mg Oral     8 T.Iron Folic Acid O D 100 mg Oral    

13. PHARMACIST INTERVENTIONS The prescription was rational. No DDI or ADRs were found.

14. S.No DRUGS FREQUENCY DOSE ROA 1 T.Paracetamol OD - SOS 500 mg Oral 2 T.Pantoprazole OD 40 mg Oral 3 T.Atenolol OD 50 mg Oral 4 T.Diclofenac OD 50 mg Oral 5 T.B-Complex OD 50 mg Oral 6 T.Iron Folic Acid OD 100 mg Oral DISCHARGE MEDICATION : -

15. LIFESTYLE MODIFICATIONS :- PATIENT COUNSELLING Avoid the alcohol consumption, Advice the patient to take the medication daily, Avoid the diet which contains high fat content, Do not stop the medication without consultation of doctor, Avoid the drugs which are toxic or hazardous to Pancreas.

16. Regarding medication ONDAN( Ondansetron ) It is an antiemetic agent used to treat nausea and vomiting caused due to certain medical conditions. It works by blocking the action of a chemical substance that causes nausea and vomiting T . RANTAC ( Ranitidine) It is an anti ulcerative agent and should be taken twice a day before food . T.FLAGYL(Metronidazole) It is an antibiotic used against certain bacteria and protozoa , used to treat a wide variety of infections induced by microbes but it wont stand against viruses

17. Paracetamol 650mg BID is used as an anti-pyretic. It act as a pain killer and also as temp lower. Given for 4 days B. COMPLEX The B vitamins are eight water-soluble vitamins that play important roles in cell metabolism. Supplements containing all eight are generally referred to as a vitamin B complex. Suggested for 7 days , so as to ensure the patients health and improve the resistivity to the infection . Tab.Pantop : It is of 40mg orally preferably should take 30min before breakfast once a day which decreases acid secretion in stomach, nausea, vomiting, dizziness, headache, abdominal distension are common side effects .

18. DISCUSSION :- Definition :- Acute pancreatitis is an inflammatory condition of the pancreas, clinically characterised by acute abdominal pain & elevated levels of pancreatic enzymes in the blood . ETIOLOGY :- * Alcohol *Gallstones *Drugs *Autoimmune *Genetic *Abdominal traum *Infections *Metabolic - hyperglycemia, hyperparathyroidism, hypertriglyceridemia

19. SYMPTOMS : Abdominal discomfort, Abdominal pain, Nausea, Vomitings, Hypertension, Pancreatic cell necrosis and Dyspnea.

20. T h a n k y o u …..