Case Presentation On Renal Calculi with Type II Diabetes Mellitus By Riya Mariam

Patient with renal calculi at UV Junction with Type II DM

1. PHARMACOTHERAPEUTICS-II II SESSIONAL PRACTICAL EXAMINATION. PRESENTED TO: Mr. APOLLO JAMES. LECTURER NANDHA COLLEGE OF PHARAMCY PRESENTED BY: RIYA MARIAM. III PHARM.D

2. CASE STUDY PRESENTATION

3. CASE STUDY ON RENAL CALCULI.

4. SUBJECTIVE : A 55 year old male patient was admitted at PMCH on 06-06-2017 with the complaints of abdominal pain in the (L) lumbar region for past 15 days.

5. HISTORY OF PRESENT ILLNESS: H/O abdominal pain in(L) lumbar region.-past 15 days. Pricking type of pain. H/O vomiting -past 2 days(contains food particle). H/O Increased frequency of micturition .(7 times during night).

6. PAST HISTORY: K/C PT under ATT(Completed ATT 6 months before 2 years). K/C DM from past 7 years. PAST MEDICATION HISTORY: INSULIN(5-0-5) PERSONAL HISTORY: Diet-Mixed. Smoking-(+) Alcohol-(+)

7. GENERAL EXAMINATION: Conscious,Oriented. Febrile(+) PR:78b/min BP:110/70mm/Hg.

8. SYSTEMIC EXAMINATION: CVS :S1,S2(+) P/A : Soft,Tenderness(+)in left lumbar region. R.S : BAE(+)

9. OBJECTIVE : NAME OF INVESTIGATION OBSERVED VALUE NORMAL VALUE HAEMATOLOGY: WBC 20.7x10 ⁹/L 4-10x10 ⁹/L L M G% 21%;14.9%;70% 20-40%;3-15%;50-70% RBC 3.8x10 ¹²/L 3.5-4.5x10 ¹²/L PLT 340x10 ⁹/L 100-300x10 ⁹/L Hb 9.7g/dl 12-16g/dl MCV 78.7fl 80-100fl MCH 24.4pg 27-34pg MCHC 33.3g/dl 32-36g/dl HCT 29.1% 37-54% RBS 385mg/dl 80-120mg/dl FBS 200mg/dl 70-100mg/dl PPBS 280mg/dl <140mg/dl

10. B.UREA 65mg/dl 10-50mg/dl S.CREATININE 1.9mg/dl 0.7-1.4mg/dl URINE ANALYSIS: COLOUR Pale Yellow REACTION Acidic Pus.cells 10-12/HPF <5/HPF Epi.cells 1-2/HPF <5/HPF SUGAR (+) ALBUMIN (+)

11. OTHER INVESTIGATIONS: USG Abdomen: (L)RENAL CALCULI with mild hydronephrosis due to the UV Junction calculi of size 4.7mm.

12. ASSESSMENT : DIAGNOSIS: RENAL CALCULI AT UV JUNCTION WITH TYPE II DIABETES MELLITUS.

13. TREATMENT PLAN: S.N DRUG NAME GENERIC NAME DOSE ROUTE FRQ DAYS 6/7 7/7 8/7 9/7 10/7 11/7 12/ 7 1. IVF NS Normal Saline √ √ √ √ √ √ √ 2. INJ.TRAMADOL Tramadol 50mg IM SOS √ √ √ √ √ √ √ 3. T.NORFLOX Norfloxacin 400mg ORAL 1-0-1 √ √ √ √ √ √ √ 4. T.URISPAS Flavoxate 200mg ORAL 1-0-1 √ √ √ √ √ √ √ 5. SYP.CITRAL KA Di Sodium Hydrogen Citrate 10ml ORAL 1-1-1 √ √ √ √ √ √ √ 6. T.RANTAC Ranitidine 150mg ORAL 1-0-1 √ √ √ √ √ √ √ 7. T.BCT Vitamin B Complex 100mg ORAL 1-0-1 √ √ √ √ √ √ √ 8. INSULIN 5-0-5 SC 5-0-5 √ √ √ √ √ √ √ 9. INJ.XONE Ceftriaxone 250mg IV 1-0-1 √ √ √ - - - - 10. T.TENGLYN Teneligliptin 20mg ORAL 1-0-0 - - √ √ √ √ √ 11. T.GLIMEPIRIDE Glimepiride 2mg ORAL 1-00 - - √ √ √ √ √ 12. SYP.SUCRALFATE Sucralfate 5mg ORAL TDS - - - - √ √ √ 13. INJ.TAXIM Cefotaxime 500mg IV 1-0-1 - - √ √ √ √ √

14. 14. T.AMLONG Amlodipine 2.5mg ORAL 1-0-0 - - - - √ √ √ 15. INJ.PERINORM Metoclopramide 5mg IV 1-0-0 - - - - √ √ √ 16. T.PAN Pantoprazole 40mg ORAL 1-0-1 - - - - √ √ √ 17. PLENTY OF ORAL FLUIDS. √ √ √ √ √ √ √

15. DISCHARGE SUMMARY: The patient was discharged on 13-06-2017 . DISCHARGE ADVICE : SRD DD BIPHASIC INSULIN (5-0-5) REVIEW AFTER 15 DAYS. RANTAC 150mg (1-0-1) T.AMLONG 2.5mg (1-0-0) T.TRAMADOL 50mg SOS

16. PLAN: DISEASE BASED COUNSELLING: FOR RENAL CALCULI: Advised the patient to stay hygiene to prevent further infection. Monitor regularly with X-rays and urine studies to be sure no new stones are forming. Advised the patient to take medication to reduce the risk of future stones.

17. FOR DIABETES MELLITUS: Educated the patient about the disease and to practice self care. Monitor the blood glucose level regularly. Avoid alcohol intake and smoking. Monitor the bodyweight . Foot care should be maintain. Advised the patient to maintain the personal hygiene.

18. DRUG BASED COUNSELLING: FOR RENAL CALCULI: TRAMADOL: Use Tramadol only when pain is felt. Patient is advised not to take tramadol while he is in intoxicated stage. Advised the patient not to crush the Tramadol Tablet. RANITIDINE: Patient is advised to take the antacid before 2hours of food.

19. FOR DIABETES MELLITUS: INSULIN: Instructed the patient to self administer the insulin. Drawing of insulin from the vial. Site of self injection. Injection techniques. Rotating the injection site. Disposal of the needles. Time of administration. Storage of Insulin. Adverse drug reactions.

20. DIET BASED COUNSELLING: FOR RENAL CALCULI: Increase fluid intake to maintain urine output. Reduce Salt Intake. Reduce the amount of meat and animal protein eaten. Avoid coffee and other stimulants ,alcohol. Eat more high fiber foods including beans, root vegetables (such as potatoes). Increase intake of citrate –rich fruits.(lemon,orange juice) Eat fewer oxalate-rich foods.

21. FOR DIABETES MELLITUS: Should Limit carbohydrate servings (sugar , starch). Restrict protein in the presence of renal dysfunction. Limit Sodium intake. Limit Saturated fats and dietary cholesterol. Avoid Alcohol consumption. Advised him to carry hard candy or glucose tablets .

22. PHARMACIST INTERVENTION: The Iron Supplements are not prescribed eventhough the patient is anaemic. Antiemetic drugs like EMESET ( Ondansetron ) is not prescribed in the starting days.

23. THANKYOU