case studies

1. CASE PRESENTATION ON
COMMUNITY ACQUIRED PNEUMONIA
Submitted by : Amar Prasad Chaudhary
V PHARM-D
Department of clinical practice,
MALLIGE COLLEGE OF PHARMACY,Silvepura,Bangalore-90

2. COMMUNITY ACQUIRED PNEUMONIA
• Pneumonia is defined as the inflammation of the lungs parenchymal cell so it
will mainly affects alveoli of lungs.
• It is characterized by alveoli filled by mixture of inflammatory exudate,
bacteria, and WBC
• Community-acquired pneumonia (CAP) is infectious pneumonia in a person
who has not recently been hospitalized.
• CAP is the most common type of pneumonia. The most common causes of
CAP vary depending on a person's age, but they include Streptococcus
pneumoniae, viruses, the atypical bacteria, and Haemophilus influenzae.
• Overall, Streptococcus pneumoniae is the most common cause of community-
acquired pneumonia worldwide.

3. SIGN AND SYMPTOMs
• Fever
• Chills
• Dyspnea
• Productive cough
• Hemoptysis
• Bluish lips

4. DEMOGRAPHIC DETAILS
• Patient name : ABC
• Age : 23 years
• Sex : male
• Date of admission : 4-12-2019
• Date of discharge : 9-12-2019

5. SUBJECTIVE EVIDENCE
COMPLAINTS ON ADMISSION
• c/o cough since yesterday
• c/o fever since yesterday
• c/o right chest pain since yesterday ( severe)

6. PAST MEDICAL HISTORY
• Prehypertensive
• Post bilateral tonsillectomy (2011)
• was admitted for atypical pneumonia 2 years back
PAST MEDICATION HISTORY
Not on medication

7. Social history
• Appetite : decreased
• Sleep : disturbed
• Bowel and bladder : dysuria
• Diet : mixed

8. General physical examination
• B.P : 110/70 mm hg
• RR : 28 cycles per min
• Temp : 98F
• Sp02 : 97%
SYSTEMIC EXAMINATION
• CVS : S1 S2 (+)
• CNS : CONCIOUS, ORIENTED
• RS : B/L NVBS
• PELVIC PULSES : FELT
• PA:SOFT
• GCS: conscious, oriented

9. PROVISIONAL DIAGNOSIS
• Viral fever along with myalgia
• pharyngitis

10. OBJECTIVE EVIDENCE
4-12-2019
Urine routine
Colour : yellow ( pale yellow)
Protein : present (+ ) ( absent)
Renal profile
Creatinine : 1.35mg/dl (0.9-1.30)
egfr: 134.0 meq/l (136-145)
ESR :19 mm/hr (0-10)

11. • CBC
MCV : 81 Fl (83-101)
Total count (TC): 22250 cells/cumm (4000-10000)
Neutrophils : 87% (40-80)
Lymphocytes : 09% (20%-40%)
Platelet count: 2.74 lahs/cu mm (1.40-4.50)
(note: monitoring of platelet required as it reduces in sepsis)
• PROCALCITONIN: 13.60 ng/ml (severe bacterial infection, sepsis
or septic shock) (0.1ng/ml)
• LFT
• Direct bilirubin: 0.28 mg/dl (0.0-0.2)
• GGT : 142.00 u/l (.0-60)

12. ABG Without Lactate (10:35)
pH 7.450 (7.380-7.440)
PCo2 34.00 (35.00-45.00)
P02 57 (75.00-100.00)
20:54
pH 7.460 (7.380-7.440)
PCo2 31.00 (35.00-45.00)
P02 48.00 (75.00-100.00)

13. 5-12-2019
CBC
• TC 31920 cells/cu mm 4000-10000
• Neutrophils 94.6% 40.0-80.0
• Lymphocytes 03.2% 20.0-40.0
• Prothrombin time test:17.3 sec 12.5-15.6
• Platelet count : 2.54 lakhs
• ABG improved to normal due to subject on BIPAP

14. ABG without lactate (19:56)
• PH 7.490 (7.380-7.440)
• PCo2 25.60 mmHg (35.00-45.00)
• PO2 105.00 mmHg (75.00-100.00)
• Chest x-ray
• Mild inspiratory film
• Haziness in right paracardiac and left mid and lower zones ? consoltation

15. Sputum smear
• Gram stain
• Ocassionally gram positive cocci (streptococci and micrococci) and
gram negative bacilli

16. 6/12/2019
• Chest AP (x-ray report)
• Mild inspiratory film.
• Diffuse inhomogeneous haziness noted in bilateral lung firlds?
Consolidation
• Bilateral costophrenic angles are hazy? Pleural effusion
• ABG
• Pco2 34.6 mmHg (35.00-45.00)
• Po2 67.00 mmHg (75-100)

17. CBC
• WBC 21440
• NEUTROPHILLS 90%
• LYMPHOCYTES 08%

18. 7/12/2019
• CBC
• WBC 15200
•9/12/2019
• WBC 12220
• CREATININE 0.81

19. GOALS OF THERAPY
• To reduce the sign and symptom of the disease
• To prevent the further complication of the disease
• To cure the infection
ASSESSMENT
From subjective and objective evidence it was found that patient
was suffering from
• bilateral pneumonia, sepsis along with septic shock
• Sepsis induced acute kidney injuiry (resolved)
• Primary immunodeficiency under evaluation
• type1 respiratory failure

20. Medication treatment CHART
DAY 1
BRAND NAME GENERIC NAME INDICATION DOSE
(MG)
ROUTE FREQUENCY TIME
C. Vizylac Rich Probiotics and
MVI
Immune
deficiency
1 cap PO 1-0-0 AF
T.pantodac pantoprazole gastitis 40mg PO 1-0-0 BF
Inj.tramazac tramadol analgesics 50mg IV stat
Inj.PCT paracetamol pyretics 1gm IV Stat and sos
Syp.Reswas levodropropizin
e+chlorphenira
mine
expectorant 30mg/2mg PO 1-0-1 AF
T.claribid clarithromycin pneumonia 500mg PO 1-0-1 AF
c.antiflu oseltamavir Viral infection 75mg PO 1-0-1 AF
T.dolo paracetamol pyretics 650mg PO sos AF

21. BRAND NAME GENERIC NAME INDICATION DOSE
(MG)
ROUTE FREQUENCY TIME
T.TELECAST-F MONTELUCAST BRONCODIALAT
ION
10/120 PO 0-0-1 PO
T.ABPHYLIN-N ACEBROPHYLLI
NE AND ACETYL
CYSTEINE
BRONCHODIAL
ATION
100/600 PO 1-0-1 PO
INJ.MICROPENE
M
MEROPENEM SEPSIS 1gm IV 1-1-1 IV
INJ.LESURIDE LEVOSULPIRIDE GUT MOTILITY 25mg IV STAT & 1-0-1 IV
T.ULTRACET
SEMI
PCT/TRAMADO
L
ANALGESIC 325/18.5 PO STAT PO
INJ.VITNEURION VIT B COMPLEX NEUROPATHY 2 amp IN
100ML
IV STAT IV
D 360 VIT D WEAKNESS 6000unit PO 1-0-0 PO
INJ.SOLUMEDR
OL
METHYLPREDNI
SOLONE
SEPSIS 125mg
40MG
IV STAT
1-1-1
IV
INJ.NORAD NORADRENALI
NE
HYPOTENSION 4ml/hr
5mg in 5oml
IV CONTINUOUS IV

22. DAY2
BRAND NAME GENERIC
NAME
INDICATION DOSE
(MG)
ROUTE FREQUENCY TIME
INJ.MICROPEN
EM
MEROPENEM SEPSIS 1gm IV 1-1-1 IV
T.claribid clarithromycin pneumonia 500mg PO 1-0-1 AF
c.antiflu oseltamavir Viral infection 75mg PO 1-0-1 AF
T.pantodac pantoprazole gastitis 40mg PO 1-0-0 BF
T.ABPHYLIN-N ACEBROPHYLLI
NE AND
ACETYL
CYSTEINE
BRONCHODIAL
ATION
100/600 PO 1-0-1 PO
T.TELECAST-F MONTELUCAST BRONCODIALA
TION
10/120 PO 0-0-1 PO
T.dolo paracetamol pyretics 650mg PO sos AF
Inj.PCT paracetamol pyretics 1gm IV Stat and sos

23. BRAND NAME GENERIC
NAME
INDICATION DOSE
(MG)
ROUTE FREQUENCY TIME
INJ.TRANEXA Trenaxamic
acid
BLEEDING 500MG PO 1-1-1 IV
Inj.EFCORLIN HYDROCORTIS
ONE
SESPSIS 50MG IV 1-1-1 IV
INJ.DERIPHYLLI
N
THEOPHYLLINE
AND
ETIOPHYLLINE
BRONCHODIAL
ATION
1CC IV 1-1-1 IV
T. SHELCAL CALCIUM LOW CALCIUM 500MG PO 1-0-1 PO

24. DAY3
BRAND NAME GENERIC
NAME
INDICATION DOSE
(MG)
ROUTE FREQUENCY TIME
INJ.MICROPENE
M
MEROPENEM SEPSIS 1gm IV 1-1-1
T.claribid clarithromycin pneumonia 500mg PO 1-0-1 AF
c.antiflu oseltamavir Viral infection 75mg PO 1-0-1 AF
T.pantodac pantoprazole gastritis 40mg PO 1-0-0 BF
T.ABPHYLIN-N ACEBROPHYLLI
NE AND ACETYL
CYSTEINE
BRONCHODIAL
ATION
100/600 PO 1-0-1 AF
T.TELECAST-F MONTELUCAST BRONCODIALAT
ION
10/120 PO 0-0-1 AF
INJ.DERIPHYLLI
N
THEOPHYLLINE
AND
ETIOPHYLLINE
BRONCHODIAL
ATION
1CC IV 1-1-1
T. SHELCAL CALCIUM LOW CALCIUM 500MG PO 1-0-1 AF
T.HYDROCORT HYDROCORTIS
ONE
SEPSIS 50MG PO 1-1-1

25. DAY 4
BRAND NAME GENERIC NAME INDICATION DOSE
(MG)
ROUTE FREQUENCY TIME
INJ.MICROPENE
M
MEROPENEM SEPSIS 1gm IV 1-1-1
T.claribid clarithromycin pneumonia 500mg PO 1-0-1 AF
c.antiflu oseltamavir Viral infection 75mg PO 1-0-1 AF
T.pantodac pantoprazole gastritis 40mg PO 1-0-0 BF
T.ABPHYLIN-N ACEBROPHYLLI
NE AND ACETYL
CYSTEINE
BRONCHODIAL
ATION
100/600 PO 1-0-1 AF
T.TELECAST-F MONTELUCAST BRONCODIALAT
ION
10/120 PO 0-0-1 AF
INJ.DERIPHYLLI
N
THEOPHYLLINE
AND
ETIOPHYLLINE
BRONCHODIAL
ATION
1CC IV 1-1-1
T. SHELCAL CALCIUM LOW CALCIUM 500MG PO 1-0-1 AF
T.HYDROCORT HYDROCORTISO
NE
SEPSIS 50MG PO 1-1-1

26. Day 5
BRAND NAME GENERIC
NAME
INDICATION DOSE
(MG)
ROUTE FREQUENCY TIME
INJ.MICROPENE
M
MEROPENEM SEPSIS 1gm IV 1-1-1
T.claribid clarithromycin pneumonia 500mg PO 1-0-1 AF
c.antiflu oseltamavir Viral infection 75mg PO 1-0-1 AF
T.pantodac pantoprazole gastritis 40mg PO 1-0-0 BF
T.ABPHYLIN-N ACEBROPHYLLI
NE AND ACETYL
CYSTEINE
BRONCHODIAL
ATION
100/600 PO 1-0-1 AF
T.TELECAST-F MONTELUCAST BRONCODIALAT
ION
10/120 PO 0-0-1 AF
INJ.DERIPHYLLI
N
THEOPHYLLINE
AND
ETIOPHYLLINE
BRONCHODIAL
ATION
1CC IV 1-1-1
T. SHELCAL CALCIUM LOW CALCIUM 500MG PO 1-0-1 AF
T.HYDROCORT HYDROCORTIS
ONE
SEPSIS 50MG PO 1-1-1

27. PROGRESS CHART
PARAMETERS DAY1 DAY2 DAY3 DAY4 DAY 5
BP (MM HG) 90/70 110/70 130/80 130/80 130/80
PULSE (BPM) 140 135 123 100 80
RR ( CPM) 48 35 32 30 28
SPO2 (% @room
temp)
97% 97% 98% 96% 99%

28. Planning
discharge medication
BRAND NAME GENERIC NAME DOSE FREQUENCY TIME DAYS
T.FARONEM FAROPENEM 200MG 1-0-1 AF 5
T.CLARIBID CLARITHROMYCIN 500MG 1-0-1 AF 3
T.PAN PANTOPRAZOLE 40MG 1-0-0 BF 5
T.ABPHYLLINE N ACEBROPHYLLINE
/ N-
ACETYLCYSTEINE
100/600 1-0-1 AF 10
T.TELECAST F MONTELUCAST/
FEXOFENIDINE
10/120 0-0-1 AF CONTINUE
T.DERIPHYLLINE R
SR
THEPHYLLINE AND
ETIOPHYLLINE
1-0-1 AF 15
T. SHELCAL CALCIUM 500MG 1-0-1 AF CONTINUE

29. Pharmacist intervention
• LESURIDE ERROR PRONE ABBRIBATION 25G INSTEAD OF 25MG
• SIGNATURE AND KMC NO. NOT WRITTEN
• DRUG INTERACTION
• NOTHING SIGNIFICANT

30. Counselling points
• Use of mask in the public place
• Should not smoke
• Drink more fluids
• Wash hands frequently
• Do some aerobic exercises
• If you get hypotension or diarrhea consult with your physician
• Take pantoprazole 30 min before food