A case study on acute renal failure

It may serve the academic needs of medical & pharmacy students

1. Case study on Acute Renal Failure 21-02-14

2. Name : X Age : 63 Sex : Male DOA: 25/6/12 DOD: 30/6/12 Chief complaints: C/O abdominal distension and puffy face with C/O severe head ache. H/O fever with breathing difficulty X 5 days. Lower limb swelling X 1 month. H/O occasional Seizures X 2 days. Past medical history: K/C/O HTN, DM X 20 years. K/C/O Renal calculi.

3. Past medication history : Diltiazem – 30mg, Insulin, Metformin – 500mg Personal/Social history : Alcoholic, smoker, Married. On examination: Physical examination: Conscious/Oriented/ Oedema . Temp: 100.1 ºF Pulse: 82 beats/min. BP: 160/120 mm/Hg. System examination : CVS: S1S2+ RS: BAE(-), Wheezing+ CNS: NFND ABD: Ascites +

4. Lab investigations Haemoglobin 10.4g/dl 14-18g/dl Platelet 130 x 10mm3 150-400 Blood sugar FBS 250mg/dl 70 to 110mg/dl Rbs 385 80-110mg/dl PPBS 340 Less than 180mg/dl RENAL BUN 58g/dl 8-23mg/dl Cr 2.8g/dl 0.6-1.2mg/dl Na 130mmol/l 135 - 145 mmol /liter K 4.5mmol/l 3.5 - 5.0mmol/l Cl 94mmol/l 98 - 108 mmol /L. Bicarb 23mmol/l 22-30mmol/L.

5. Urine analysis Color Clear yellow pH 6.5 Sugar Trace Protein 84mg/dl 60-140mg/dl ESR 20 – ½ hr 5-15mm Diagnosis: Acute renal failure, Diabetic nephropathy, Systemic HTN, DM - II

6. DRUG CHART DRUGS ROA DOSE DOSAGE No.OF DAYS Inj.FUROSEMIDE IV 60mg OD X 5 days Inj. PANTOPRAZOLE IV 40mg BD X 5 days Neb. BUDESONIDE P/N 0.5mg Stat X 2days T. DILTIAZEM P/O 30mg OD X 5 days T. CLOPIDROGEL P/O 75mg OD X 5 days T. SUPRDAYN P/O 100mg OD X 5 days T. LEVOCETRIZINE P/O 5mg OD X 3 days Neb. IPRATROPIUM BROMIDE + SALBUTAMOL P/N 500mcg/ 2.5mg Stat X 3 days T. GLIMEPIRIDE P/O 2mg OD X 5 days T. METFORMIN P/O 500mg BD X 5 days INJ. FOSPHENYTOIN IV 5U BD X 5 days

7. Discharge advice T. FUROSEMIDE - 40mg (OD) T.CLOPIDROGEL - 75mg (BD) T. METFORMIN – 250mg ( BD) Drug interactions: Budesonide vs Clopidrogel vs Fosphenytoin Budesonide will decrease the level of of clopidrogel by affecting/intestinal enzyme CYP3A4 metabolism.(significant-monitor closely)