This document presents a case study of a 54-year-old male patient admitted with complaints of epigastric pain, decreased urine output, nausea, vomiting and itching. The patient has a history of type 2 diabetes mellitus, hypertension and chronic kidney disease. Laboratory investigations showed increased urea, creatinine and alkaline phosphatase levels, indicating chronic kidney disease. The patient was assessed and diagnosed with type 2 diabetes mellitus, hypertension and chronic kidney disease. He was treated with insulin, enalapril, torsemide and other medications and showed improvement in symptoms over two days.

1. CASE STUDY ON- DM-2, HTN, CKD
D I V Y A N S H U R A J P U T
R O L L N O . 1 8 1 3 7 5 8
C L A S S - P H A R M D 2 N D Y E A R
D E P T . O F P H A R M A C Y P R A C T I C E
I S F C O L L E G E O F
P H A R M A C Y
E M A I L :
D I V Y A N S H U R A J P U T D R @ G M A I L . C O M
ISF College of Pharmacy, Moga
Ghal Kalan GT Road, Moga- 142001, Punjab, INDIA

2. ABOUT DISEASE
T2DM : -
Type 2 diabetes mellitus (T2DM) is a metabolic disorder and typically results from excess of caloric
intake over energy expenditure. It is characterized by a progressive insulin secretory defect due to
insulin resistance, which increases the body’s demand for insulin in order to retain glucose
homeostasis. If pancreatic β-cells fail to secrete enough insulin to compensate for increasing insulin
demand, the blood glucose level will be elevated gradually.
HTN (Hypertension) : -
Hypertensive heart disease refers to heart conditions caused by high blood pressure. Or,
Hypertension is a condition when your systolic blood pressure is higher than 140 mmHg and your
diastolic blood pressure is above 90 mmHg, averaged over time. Sometimes, a patient may have
elevated blood pressure in the doctor's office but not at any other time. This is called white coat
hypertension
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3. CKD(Chronic Kidney Disease): -
Chronic kidney disease, also called chronic kidney failure, describes the gradual loss of kidney
function. Your kidneys filter wastes and excess fluids from your blood, which are then excreted in
your urine. When chronic kidney disease reaches an advanced stage, dangerous levels of fluid,
electrolytes and wastes can build up in your body.
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4. PATIENT PROFILE
 Name:-XXX
 Age: -54
 Sex: - Male
 DOA: -21/07/2019
 Occupation: -Salesman
 Past Medical History :-K/C/O DM-2,HTN.
 Social History: - Non-Alcoholic and non-
smoker
 Allergy: - No such allergy found
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5. SUBJECTIVE
CHIEF COMPLAINTS
Reason for admission:-
Patient was having epigastric pain since 4 days
 Complaints :-
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Patient complain Duration
Epigastric pain 4 days
Decrease urine output 4 days
Nausea And Vomiting 4days
Itching 2-3 days

6. Vitals
I S F C P 6
Vitals Observed
BP(Blood Pressure) 140/90 mmHg
Pulse 98/min
SPO2(oxygen saturation) 100%
ECG S and T WAVE
RBS(random blood sugar test) 126 mg/dl

7. LABORATORY INVESTIGATIONS ( -DECREASE --NORMAL -INCREASED)
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TEST OBSERVED VALUE NORMAL VALUE INDIACTIONS
UREA 24.9 mg% 7-20 mg%
CREATININE 4.3 mg% 0.8-1.3 mg%
WBC 6000mcl 4500-11000mcl
RBC 5.2 million cell per mcl 4.5-6.1 million cell per mcl
HGBT 7.1 g/dl 12-16 g/dl
SGOT 35 IU/L 5-40 IU/L
SGPT 16 IU/L 5-40 IU/L
ALP 164 IU/L 60-150 IU/L
Na+ 138 meq/L 135-155 meq/L
K+ 3.8 meq/L 3.5-5.5 meq/L
Cl- 88.0 98-107.0 meq/L
SGOT-Serunm Glutamic Oxaloacetic
Tranisaminase
SGPT-Serum Glutamic Pyruvic Transaminase
ALP-Alanine Phosphate

8. ASSESSMENT
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From subjective and objective evidence, it has been diagnosed as that
patient is suffering from-
DM-2,Hypertension And Chronic Kidney
Disease
THERAPEUTIC GOALS
Patient specific : To Provide Symtomatic Releif
Disease specific : to provide preventive treatment of disease.

9. TREATMENT CHART
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Drugs Dose Route Freq D1 D2
Inj Insulin (INSULIN) 8 u IV BD + +
Tab Minipril(ENALAPRIL MALEATE) 5mg Oral BD + +
Tab Dytor(TORSEMIDE) 10mg Oral BD + +
Inj Vit K3 10mg IV OD + +
Inj Calcium Gluconate 10ml IV TDS + +
Tab RAN TAC(RANITIDINE) 150mg Oral BD + +
Tab NodoSIS(SODIUM BICARBONATE) 10mg Oral BD + +
Tab Ecospirin(ASPIRIN) 0.4ml Oral BD + +
Tab Clavix(CLOPIDOGREL) 75mg Oral OD + +
Tab Cilacar(CLINIPIDINE) 10mg Oral OD + +
Inj Heparin (SODIUM CHLORIDE) 0.4ml IV BD + +

10. ABOUT DRUGS
Inj Insulin
Insulin injection is used to control blood sugar in people who have type 1 diabetes or in people who
have type 2 diabetes that cannot be controlled with oral medications alone. Insulin injection is in a
class of medications called hormones. Insulin injection is used to take the place of insulin that is
normally produced by the body.
Tab Miniprin
Aspirin is used to reduce fever and relieve mild to moderate pain from conditions such as muscle
aches, toothaches, common cold, and headaches. It may also be used to reduce pain and
swelling in conditions such as arthritis. Aspirin is known as a salicylate and a nonsteroidal anti-
inflammatory drug (NSAID).
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11. Tab RAN TAC
Rantac 150 MG Tablet is a very effective medicine that is used to reduce the amount of acid
produced in the stomach. It is used to treat and prevent stomach acid-related disorders such as
heartburn and acid reflux disease.
TAB NODO SIS
It acts as a buffer against an excess acidic condition of the body by raising blood pH. It increases the
urinary pH by increasing the excretion of free bicarbonate ions in the urine
Tab Ecospirin
Aspirin is used to reduce fever and relieve mild to moderate pain from conditions such as muscle
aches, toothaches, common cold, and headaches. It may also be used to reduce pain and
swelling.
ISF CP
11

12. Tab Cilacar
Cilnidipine decreases blood pressure and is used to treat hypertension and its comorbidities. Due
to its blocking action at the N-type and L-type calcium channel, cilnidipine dilates both
arterioles and venules, reducing the pressure in the capillary bed.
Tab Clavix
Clavix 75 MG Tablet is antiplatelet which is used to prevent clots in blood vessels. It can be taken
in combination with other antiplatelets for a better action. It is not recommended in patients
with bleeding disorders.
Inj Heparin
Heparin is an anticoagulant (blood thinner) that prevents the formation of blood
clots. Heparin is used to treat and prevent blood clots caused by certain medical conditions or
medical procedures. It is also used before surgery to reduce the risk of blood clots
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13. Tab Dytor
Dytor 10 MG Tablet is a diuretic which is used to control high blood pressure and edema. It is
usually taken once daily, preferably in the daytime to prevent sleep disturbances. Do not take this
medicine if you have a known allergy to it.
Inj Cal Gluconate
Calcium gluconate is a mineral supplement and medication. As a medication it is used by injection
into a vein to treat low blood calcium, high blood potassium, and magnesium toxicity.
Supplementation is generally only required when there is not enough calcium in the diet.
Inj Vit K
Vitamin K is used to treat and prevent low levels of certain substances (blood clotting factors) that
your body naturally produces. These substances help your blood to thicken and stop bleeding
normally (e.g., after an accidental cut or injury). Low levels of blood clotting factors increase the
risk for unusual bleeding.
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14. PROGRESS CHART
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DAY PROGRESS
1
C/O Epigastric Pain,C/O Nausea
And Vomiting, C/O Itching,And
Decrease urine output.
2 NO C/O Epigastric pain, Nausea,
Vomiting, and Itching.

15. PATIENT COUNSELLING
Patient must not consume fatty diet or high calorie diet because it may lead to more
obesity and effect heath and may affect the therapeutic plan for the patient.
As above the patient is hypertensive so the patient must consume low salt diet.
Attend regular check-ups with your doctor to get the best care possible.
Rest whenever you feel tired to avoid overtaxing your body and immune system.
Do gentle exercises like walking and swimming as frequently as you are able.
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16. THANK YOU
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