CASE STUDY ON Urinary Tract Infection

CASE STUDY ON Urinary Tract Infection

1. CASE STUDY ON Urinary Tract Infection Presented By: MAKBUL HUSSAIN CHOWDHURY Pharm. D 4 th Year

2. UTI -An Overview UTIs are common, especially among women * UTIs in men are less common and primarily occur after 50 years of age * UTIs infection usually occur by ascending route (urethra to bladder) * UTIs infection is less common by haematogenous spread (kidney) * UTIs occur in two general settings: community-acquired and hospital acquired.

3. * Urethritis : Infection of anterior urethral tract dysuria, urgency and frequency of micturition - Dysuria ;(burning pain on passing urine) - Urgency ;(the urgent need to pas urine) - Frequency of micturition * Cystitis : Infection of urinary bladder dysuria, frequency, pyuria and haematuria * Bacteriuria : Presence of bacteria in urine A count of 100 organisms/ml or more in urine * Pyuria : Presence of pus in urine (more than 10 cells/HPF) Pyelonephritis : Infection of kidney ; flank pain, pyuria, fever, chills, nausea

4. Clinical Features Acute lower UTIs ( Urithritis and cystitis): Rapid onset of: - Dysuria (burning pain on passing urine) - Urgency (the urgent need to pas urine) - Frequency of micturition Upper UTIs ( Pyelonephritis ): - Fever - Chills - Dysuria - Urgency - Frequency of micturition Etiology Of Urinary Tract Infections Causative organisms: 1- Bacterial 2- Viral 3- Fungal 4- Protozoal

5. OTHER RISK FACTORS; Sex Anatomy and Physiology of woman’s organ. Urinary Catheters. In Children’s; Due to Vesicoureteral reflux. Hyperplasia: causes obstruction of the uretra . Diabetes.

6. SOAP STUDY

7. Patient Details… CR No. : 8621/13 Age : 30 y Sex : M DOA : 29/11/17 DOD : 04/12/17 ( No. of days in hospital = 05 )

8. Chief Complaints/Presenting Symptoms… Fever with high grade chills Headache & body-ache (since last 07 days). Loose stools (since last 02 days). Vomiting (2-3 episodes)

9. Past History & Food Habits… No history of DM or TB or HTN. Family history: Not significant. Social history : No history of addiction. Vegetarian. Non-smoker.

10. Vital Chart (As On 30/11/17) BP = 130/90 mmHg Temp. = 100.2 ◦ F RR = 24/min PR = 108/min

11. Laboratory Data (as on 30/12/13 ) LAB. TEST PARAMETERS RESULTS NORMAL VALUES Total Bilirubin 0.8 mg/dl 0.2-1.3 (Adults) 1.0-10.5(Neonates) Serum Potassium 3.8 mmol /L 3.5-5.1 mmol /L Serum Sodium 135 mmol/L 137-145 mmol /L Serum SGOT 44 IU/L 14-36 IU/L (F) 17-59 IU/L (M) Serum SGPT 59 IU/L 9-52 IU/L (F) 21-72 IU/L (M) Serum BUN 13 mg/dl 7-17 mg/dl (F) 9-20 mg/dl (M)

12. Laboratory Data (As On 31/03/17) Test parameters Results Normal Values Hb .(g/dl) 13.6 11.5-16.5 TLC (/ cumm .) 5300 4000-11000 Neutrophils (%) 65 40-75 Lymphocytes (%) 32 20-45 Eosinophils (%) 00 01-06 Monocytes (%) 02 02-10 Basophils (%) 00 0-2 RBC(million/ cumm .) 4.41 3.8-4.8 Platelet ( lacs / cumm .) 1.5 1.5-4.0 MCV 90.2 0-20

13. Diagnostic tests; On 30-11-2017 Test for (MP antigen) : negative Widal = negative Urine Microscopic examination- 30-11-17 Pus cells- 6-10cells/ hpf (occasional clumf ) Epithelial cells- 2-3/ hpf

14. Assessment & treatment plan….

15. Diagnosis … Based on the reports of routine urine examination and microscopy, the present case was diagnosed as that of Urinary tract infection on 31/05/13.

16. Therapeutic Goals.. To lower the body temp. To provide the relief from headache and body-ache Prevention of vomiting. To eradicate the infection of Urinary tract and to prevent the chances of relapse.

17. Day & symptoms Medication withdrawn Medication Added Day 01 ( 30.11.17) Fever with high grade chills, headache and body-ache, yellowish discoloration of sclera, vomiting and loose stools. (PR= 76/min, RR= 22/min, BP=120/80 Temp. 101.6F) Inj. Mole (stat) ( paracetamol ) Inj.Palin 40mg, IV,BD( pantaprazole ) Inj.Geminate plus 1.5gm, TDS, IV, ( ceftriaxone ) Syp . Rqual , 2tsf,TDS (multivitamins)

18. Day & symptoms Medication withdrawn Medication added Day 02 (1.12.17) at 4pm (PR= 88/min, RR= 22/min, BP=130/90 Temp. 102.6F) Adv. – Routine urine examination and microscopy. Rx, tab. Lariago -DS 2 tb stat tb 1 after 6 hr.

19. Day & Symptoms Medication Withdrawn Medication Added DAY 03 ( 02.11.17) (BP=120/80mmHg PR=86/min, RR=22/min Temp=98.4F) GC stable, At 5pm Temp.99.6F CST Tb. Calpol given DAY 04 (02.06.13) (BP=110/80mmHg PR=76/min, RR=22/min Temp=98F) GC stable, tb . Lariago Adv. TLC tb . Norflox , 400mg , BD ( norfloxacin ) syp . Alkasol , 2tsf, TDS (disodium citrate) tb . Sibelium , 10mg, HS ( flunarizine )

20. Day & symptoms Medication withdrawn Medication added DAY 05 ( 3.12.17) (BP=130/80mmHg PR=72/min, RR=22/min Temp=98F) GC stable, No fresh complaint DAY 06 (04.06.13) (BP=120/70mmHg PR=80/min, RR=20/min Temp=98.6F) GC stable, No fresh complaint CST Patient discharged TLC reports =5600

21. DAY OF DISCHARGE (4.12.17) – Condition of the patient improved and prescription revised for discharge. Discharge summary is as follows: 1. Tab. Pantocid 400mg BD 2. Tab. Norflox 400mg BD 3. Syp . Alkasol 2tsf TDS 4. Syp . Rqual 2tsf TDS All medications for 5 days. Advice to repeat Routine Urine Examination & Microscopy tests and follow up after 5 days.

22. Clinical Justification The treatment given to the patient was almost satisfactory and the condition of patient was improved at the time of discharge but apart from this there are some instead that are: Tab. Lariago was given irrationally because if there was a negative test report of malarial parasite then why that particular drug was prescribed.

23. References… Patient case record. Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy:A Pathophysiologic Approach. 6 th ed. New York: The McGraw-Hill Companies; 2005. www.elsevierimages.com accessed on 02.06.13