Case study chronic kidney disease stage v on mhd

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1. Case Study- Chronic
Kidney Disease
Stage V on MHD
By - Vijay S
Pharm.D

2. DEMOGRAPHIC DETAILS
NAME : Mr. TS
AGE : 23
GENDER : Male
DOA : 9/02/2022
DOD : 12/02/2022

3. SUBJECTIVE EVIDENCE
HISTORY:
The patient is admitted with k/c/o Hypertension since last 4 months. CKD-
stage 5 on MHD 2 times/ week via right IJV since last 4 months.
Patient underwent left RC AVF - 2 months back.
Now presented with Fatigue, Tiredness, Breathlessness since 1 day

4. OBJECTIVE EVIDENCE
PHYSICAL EXAMINATION:
General : Pallor +
Vital signs : BP - 126/80 mm Hg
Pulse - 76/min
Respiratory : Unrecordable gasping on NA5cc
CVS : S1 and S2 heard
Resp. System : Bilateral normal vesicular breath sounds heard.
Abdomed : Soft, Bowel sounds +
CNS : NFND

5. NOTE:
Patient is received in ER as Dyspneic status with ℅ tiredness, breathlessness
since morning.
Vital signs :
BP not recordable.
Pulse rate 43/min
Random blood sugar - 152mg/dl
Last Hemodialysis 3 days ago in Kallakurichi

6. PROVISIONAL DIAGNOSIS
1.Hypotension - Septic shock
2.Secondary to CLABSI (central line associated blood stream infection)
3.Chronic kidney disease stage 5
4.? CGN on MHD
5.Status post left BC AVF

7. Laboratory Examination
Date - 9/2
PERIPHERAL SMEAR STUDY
Impression : Normocytic Normochromic to Normocytic Hypochromic anemia
with Neutrophilic Leucocytosis.
LIVER FUNCTION TEST:
TEST RESULT REFERENCE VALUE
ALBUMIN 3.1 g/dL 3.5 - 5.2 g/dL
SGOT 5770 U/L UPTO 40 U/L
SGPT 2259 U/L UPTO 41 U/L

8. COMPLETE BLOOD COUNT :
TEST RESULT REFERENCE VALUE
RBC COUNT 1.97 million/cumm 4.5 - 5.5 million/cumm
HB 5.3 g/dL 13.0 - 17.0 g/dl
HCT 17.1% 40 - 50 %
MCHC 31g/dL 31.5 - 34g/dL
RDW CV 15.2% 11.6 - 14%
TOTAL COUNT 34600/cumm 4000 - 10000/cumm
DIFFERENTIAL COUNT
NEUTROPHIL

85%
40-75%
LYMPHOCYTE 10% 20-40%
EOSINOPHIL 0% 1-6%

9. C Reactive Protein 52.7 mg/L Upto 5.0 mg/l
ELECTROLYTES
SODIUM

129 mEq/l

135 - 145 mEq/l
POTASSIUM 7.7 mEq/l 3.5 - 4.9 mEq/l
CHLORIDE 92 mEq/l 100 - 108 mEq/l
BICARBONATE 6.0 mEq/l 22 - 28 mEq/l
ARTERIAL BLOOD GAS

ABNORMAL
CREATININE
GFR value(5ml/min/1.73m2)
13.18 mg/dL 0.70 - 1.20 mg/dl
CALCIUM 7.8mg/dL 8.6 - 10 mg/dL

10. TEST RESULT REFERENCE VALUE
APPT
TEST

39.4 sec

26.2 - 34.2
CONTROL 30.2 sec
PROTHROMBIN TIME
TEST

23.9 sec

10.3 - 13.1 sec
CONTROL 11.7 sec
INR 2.09

14. USG ABDOMEN AND PELVIS

15. Diagnosis
1.CKD V on MHD - 3 weeks
2.Septic shock - Recovered
3.Hypertension
4.CRBSI (Catheter related blood infection)
5.Anemia of Chronic kidney disease - status 1 unit PRBC
6.CKD MBD (Minimal bone disorder)
7.Ischemic hepatitis

16. MEDICATION RECEIVED DURING HOSPITAL
STAY
DRUG DOSE FREQ &
ROA
DURATION
9/2
10/2 11/2 12/2
INJ. Sodium
bicarbonate
8
ampoules
IV 11am
INJ. Human
actrapid
8 units IV 11am
INJ.
Vancomycin
1gm IV stat Test dose
3:10pm
4pm

INJ. Amikacin750mg IV stat 4pm
INJ.
Hydrocortisone
100mg IV stat 11:30pm

17. INJ. calcium gluconate- IV - 7:40am - -
INJ. H Actrapid 6 units IV - 7:40am - -
INJ. Dextrose 25% 100ml IV - 7:40 - -
INJ. Lasix 60mg IV - - - 1:50pm
INJ. Pan 40mg IV
OD
4pm 8pm 8pm8pm
INJ. Tamin 1gm 4:15pm

18. TAB
Benpress
4mg PO - 12:45pm- 10om
INJ
Thiamine
100mgIV
OD
4pm 4pm 4pm 4pm

INJ
Meropenam
500mgIV
TDS
6:30pm 3am
11am
7pm
3am
11am
7pm
3am
11am
7pm
INJ Vitamin
K
2cc IV
OD
4pm 8pm 4:30pm 8pm
TAB Udiliv 300mgPO
OD
4:30pm 8am
8pm
8am
8pm
8am
8pm
TAB Shelcal- PO
TDS

- 9am
5pm
8am
2pm
8pm
8am
3:30pm
9:30pm
TAB
Sevelemer
400mgPO
TDS
- 9am
5pm

8am
2pm
8pm

8am
3:30pm
9:30pm

19. CAP
Sporolac
- PO
TDS
- 11am
8pm
8am
2pm
8pm
-
INJ
Refervit
2cc IV
OD
- 6:30pm 4pm 4pm
Zytee gelLocal
application
BD
CAP VSL
#3
PO
BD
8pm 8pm

20. DISCHARGE MEDICATIONS
1.Inj Meropenam 500mg IV BD for 5more days
2.Tab Ran 300mg OD BF
3.Tab Dragovit OD AF
4.Tab Shelcal 500mg TDS AF
5.Tab Sevelemer 400mg TDS with food
6.Capsule Sporolac TDS for 2 days
7.Zytee gel for local application
8.Inj Carbepoutin 40mg 1 week post HD
9.Inj Encicarb 500mg in 100ml NS once 2 weeks post HD
10.Tab Benpress 4mg BD
11.Tab Torgo 40mg BD

21. Indications for Medications Used
●Sodium Bicarbonate - Severe Kidney Disease and septic shock
●Human actrapid -To prevent complication of blood sugar
●Antibiotics - to treat infection in blood
●Hydrocortisone - to treat inlammation
●Calcium gluconate and shelcal- calcium deficiency
●Thiamine - fatigue and plays a role in heart function
●Vitamin K - Blood clotting factor
●Udiliv - to treat elevated liver function test
●Sevelemer - to treat high level of phosphate in blood and it increases calcium slightly
●Sporolac - probiotic
●Zytee gel - mouth ulcer

22. PHARMACIST INTERVENTION
1.AMIKACIN + VANCOMYCIN (MODERATE) may have additive nephrotoxic or
neurotoxic effects. Management: Monitor Renal function and Serum Drug Concentration.
No interactions found on any medication when administered at same time.