ACUTE ON CKD (GRADE-V) WITH ACUTE GASTROENTERITIS .pdf

A case study on acute on CKD Grade -V with acute gastroenteritis, Anasarca, anemia, diagnosis, treatment, 2D Echo, USG abdomen and pelvis, patient counseling

1. ACUTE ON CKD (GRADE-V)
WITH ACUTE
GASTROENTERITIS
V. GANAPATHI
19353D1009
PHARM. D VI YEAR
JAYAMUKHI COLLEGE OF PHARMACY
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2. SUBJECTIVE FINDINGS
A female patient of age 65 brought to the hospital with following
C/O:
•B/L lower limb swelling since 3days
•Decreased urine out put since 2days
•3 episodes of loose stools & multiple episodes of vomiting
•Generalized body swelling+ (Anasarca)
K/C/O: HTN since 10years on T. Telma 40mg OD
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3. OBJECTIVE FINDINGS
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S.N VITALS INITIAL DAY-1 DAY-2
1 ON EXAMINATION C/C/C C/C/C C/C/C
2 PULSE RATE (bpm) 60 72 73
3 B.P. (mmHg) 150/70 148/72 132/78
4 SpO2 (%) 99% on RA 100% on RA 98% on RA
5 TEMPERATURE (*F) Afebrile 100*F Afebrile
6 LUNGS NVBS NVBS NVBS
7 PARA ABDOMEN Soft Soft Soft
8 HEART S1 S2+ S1 S2+ S1 S2+
9 GCS SCORE (15) E4V5M6 E4V5M6 E4V5M6
•NOTE: B.P- Blood Pressure, C/C/C- conscious/ coherent/ cooperative, SpO2- saturation of peripheral
oxygen, GRBS- general random blood sugar, NVBS-normal vesicular breath sounds and RA- room air.

4. LAB INVESTIGATIONS
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S.N PARAMETER NORMAL RANGE RESULTS
1 Haemoglobin (gm) 13-17 7.8
2 RBC Count (M/cumm) 4.5-5.5 2.26
3 WBC Count (C/cumm) 4000-11000 7,900
4 Platelet Count (L/cumm) 1.5-4.5 2.15
5 Urea (mg/dl) 20-40 190
6 Serum Creatinine (mg/dl) 0.7-1.2 14.5
7 Serum Sodium (mmol/L) 136-145 130
8 Serum Potassium (mmol/L) 3.6-5.1 7.1
9 Serum Chloride (mmol/L) 98-108 109
NOTE: M/cumm- million/cubic millimeter, C/cumm- cells/cubic millimeter, gm- gram, L/cumm- lakh/
cubic millimeter, mg/dl- milligram/ deciliter and mmol/L- millimole/litre.

5. LAB INVESTIGATIONS
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NOTE: M/cumm- million/cubic millimeter, C/cumm- cells/cubic millimeter, gm- gram, L/cumm- lakh/
cubic millimeter, mg/dl- milligram/ deciliter and mmol/L- millimole/litre.
S.N PARAMETER NORMAL RANGE RESULTS
17 Pus Cells in Urine (HPF) 0-5 1-3
18 Epithelial Cells in Urine (HPF) 15-25 6-8
19 Arterial PH 7.3-7.5 7.0
20 PCO2 (mmHg) 35-45 39
21 HCO3 (mmHg) 22-28 10
22 PO2 (meq/L) 75-100 135

6. IMAGING FINDINGS
USG ABDOMEN & PELVIS:
•B/L Renal parenchymal changes grade-II
•Small sized both kidneys right side 7.5x3cm, left 7.5x2.8cm
•B/L pleural effusion
2D ECHO:
•Concentric LVH
•No RWMA, EF-60%
•IVC collapsing
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7. ASSESSMENT
❑On the basis of subjective, objective and imaging finding confirms
that the patient has been diagnosed with-
Acute on CKD Grade-V with Acute Gastroenteritis with Anasarca with
Anemia and Dyselectrolytemia.
❑K/C/O: HTN since 10years
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8. PHARMACOLOGICAL THERAPY
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S.N BRAND DRUG DOSE R.O.AFREQUENCY DURATION
1 REDABACT CEFOPERAZONE&
SULBACTAM
1000/500M
G
IV TWICE D1-D7
2 METROGYL METRONIDAZOLE 500MG IV THRICE D1-D7
3 PAN PANTOPRAZOLE 40MG IV ONCE D1-D7
4 LASIX FUROSEMIDE MG PO TWICE D1-D7
7 NAC N-ACETYLCYSTEINE 1.2MG PO THRICE D1-D7
8 KETOADD KETOANALOGUES 1TAB PO THRICE D1-D7
9 PROBEREN PRE & PROBIOTICS 1TAB PO TWICE D1-D7
10 K-BIND
SACHETS
CALCIUM
POLYSTYRENE
SULPHONATE
1 SACHET PO THRICE D1-D4

9. PHARMACOLOGICAL THERAPY
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S.N BRAND DRUG DOSE R.O.AFREQUENCY DURATION
11 NICARDIA NIFEDIPINE 20MG IV THRICE D1-D7
12 REDOTIL RACECADOTRIL 100MG PO TWICE D1-D2
13 DAROLAC LACTOBACILLUS 2.5 B.C PO TRICE D1-D3
14NEB’S WITH
DUOLIN
LEVOSALBUTAMOL &
IPRATROPIUM
1.25/500MGPN THRICE D1-D5
15NEB’S WITH
BUDECORT
BUDESONIDE 0.5MG PN THRICE D1-D5
16 NEOMOL ACETAMINOPHEN 500MG IV THRICE D1-D3

10. PATIENT EDUCATION
❖Take medication as advised by the doctor regularly
❖Drink minimum of 1.5 liter per day
❖Eat fresh fruits and vegetables
❖Avoid direct contact with pet animals and contaminated things
❖Regular bath with moderate hot water
❖Seek immediate medical care in case of any unwanted side effects
❖Regular physical exercise and walking
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11. HAVE A NICE DAY
[email protected]
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