ITS IS A PRESENTATION OF CHF, CKD AND ALCOHOLIC GASTRITIS .

1. CASE
PRESENTATION
PRESENTED BY KRISHNA . M 4TH PHARM D

2. CASE REPORT
ON ACUTE
ALCOHOLIC
GASTRITIS AND
CHF

3. SUBJECTIVE
A 52YEARS OLD MALE PATIENT WAS ADMITTED IN PMCH WITH THE COMPLAINTS
OF ABDOMINAL PAIN FOR PAST 20 DAYS , HEART BURN , VOMITING , FEVER FOR
PAST 4 DAYS .
3

4. HISTORY OF PRESENT
ILLNESS
• H/O ABDOMINAL PAIN FOR 20 DAYS
• H/O HEART BURN FOR 10 DAYS
• H/O VOMITING FOR 10 DAYS
• H/O FEVER FOR 4 DAYS
• H/O BURNING MICTURATION
• H/O FREQUENCY OF MICTURATION
4

5. SOCIAL HISTORY
• ALCOHOLIC FOR PAST 20 YEARS
5

6. GENERAL EXAMINATION
CONSCIOUS ORIENTED
ANEMIA +
6
SYSTEMIC EXAMINATION
CVS: S1,S2 +
RS : BAE +
P/A : SOFT EPIGASTRIC , TENDERNESS +
BP: 140/80
PR:84

7. LAB INVESTIGATION
7
PARAMETERS OBSERVED VALUE REFERENCE VALUE
Haemoglobin 10.6g/dl 11.3-14.1g/dl
ESR 46mm/hr Upto 20mm/hr
HCT 32.8% 30-39%
RBC 3.45 million/mm³ 3.80- 5.20 million/mm³
Total WBC 25,000cells/cu.mm 6000-17,500 cells/cu.mm
Lymphocytes 12.3×109/l 1.0–13.5×109/l
Monocytes 1.5×109/l 0.1–1.5×109/l
Granulocytes 8.2x109/l 1.0–8.5×109/l
Lymphocytes 53.4% 47-77%
Monocytes 6.8% 2-10%
Granulocytes 39.8% 15-45%
Platelet 655,000/mm³ 150,000-450,000/mm³
MCV 95.3fl 77-108fl
MCH 30.7pg /cell 27-35pg/cell
MCHC 32.3g/dl 32-36g/dl

8. 8
PARMETERS OBSERVED VALUE REFERENCE VALUE
RBS 95mg/dl 80-140mg/dl
RENAL PROFILE
Blood Urea 138mg/dl 10-50mg/dl
Serum Creatinine 2.9mg/dl 0.6-1.9mg/dl
URINE ANALYSIS
Colour Pale yellow
PH Acidic
Albumin Nil
RBC Nil
Sugar Nil
Puss cells 2-3HPF 5-10HPF
Epithelial cells 1-2HPF 5-10/HPF
Cast crystals Nil
RA factor Negative
CRP Negative

9. 9
USG – B/L INCREASED RENAL CORTICAL ECHOES
OTHERTEST

10. ASSESSMENT
10

11. 11
• D1 ACUTE ALCOHOLIC GASTRITIS
• CAD (NOT ON RX)
• D2 ACUTE ON CHF
DIAGNOSIS

12. 12
TREATMENT CHART
SI/N
O
DRUG NAME DOSE ROUTE FREQENCY DAY 1 DAY 2 DAY3 DAY4 DAY5 DAY6
1 IVF DNS 10
2 INJ PAN 40MG 40MG IV BD      
3 GAVISON ( ALOH2 +
MGCO3)
10ML PO TDS      
4 T, PARACETAMOL 500MG PO 1-1-1      
5 T . CLOPIDOGREL 75MG PO 0-1-0      
6 T. ATROVASTATIN 10MG PO 0-0-2      
7 T. ISOSORBIDED DINITRATE 5MG PO SOS      
8 T. METOPROLOL 25MG PO 1-0-1      
9 T. SPIROLONLACTONE 25MG PO 1-0-0      
10 INJ . LASIX 20MG IV 1-1-0  

13. 13
• Metoprolol + spironolactone
Using metoprolol and spironolactone together may lower your
blood pressure and slow your heart rate.
• MANAGEMENT: Monitoring of serum potassium levels, blood
pressure, and blood glucose is recommended during
coadministration.
• ATORVASTATIN + CLOPIDOGREL - The concomitant
administration of atorvastatin may reduce the metabolic activation
of the prodrug clopidogrel and its antiplatelet effects
• MANAGEMENT: Until more information is available, monitoring
for altered efficacy of clopidogrel may be advisable if atorvastatin
is coadministered with clopidogrel.
DRUG INTRACTION

14. 14
• ATROVASTATIN + PANTOPRAZOLE - A case report suggests that
coadministration with esomeprazole may increase the plasma
concentrations of atorvastatin and the associated risk of
myopathy.
• MANAGEMENT -Because of the increased risk of
musculoskeletal toxicity associated with high levels of HMG-CoA
reductase inhibitory activity in plasma, patients treated with
atorvastatin
• CLOPIDOGREL + PANTOPRAZOLE - Coadministration of
clopidogrel with pantoprazole does not appear to significantly alter
the systemic exposure to the active metabolite of clopidogrel or
the drug's effect on platelet inhibition.
DRUG INTRACTION

15. 15
• MANAGEMENT - According to the product labeling for
pantoprazole, no dosage adjustment of clopidogrel is necessary
when administered with an approved dosage of pantoprazole.
However, it may be advisable to closely monitor the therapeutic
efficacy of clopidogrel during concomitant treatment. An H2-
receptor antagonist may be substituted if an interaction is
suspected.

16. 16
• PATIENT WAS DISCHARGED : PATIENT DISCHARGED ON 15/2/19.
• SYP GAVISCON TDS
• T. PAN 40 1-0-0
• T.SPIRONOLACTONE 25MG 1-0-0
• T.CLOPIDOGREL 75MG 0-1-0
• T. METOPROLOL 25MG 1-0-1
• T. ATROVA 10MG ODS
DISCHARGE SUMMARY

17. PATIENT COUNSELLING
17

18. 18
• PATIENT IS ADVISE TO AVOID ALCOHOL IN TAKE COMPLETELY
• PATIENT IS ADVERSED TO BE STRESS FREE
• PATIENT IS ADVISE TO PERFORM MILD EXERCISE
DISEASED BASED

19. 19
• PATIENT IS ADVERSED TO DRINK PLENTY OF WATER .
• PATIENT IS ADVERSED TO AVOID COLA , COFFEE , CITRUS FRIUT JUCISE ,
GREEN OR BLACK TEA ETC…
• PATIENT IS ADVERSED TO TAKE GARLIC EXTRACT , EACH LIGHTER
FOODS.
DIET BASED

20. 20
• ADVICE THE PATIENT TO TAKE DRUG REGULARLY , DONOT STOP OR SKIP,
THE DOSE OF DRUG . IF MISSED DO NOT DOUBLE THE DOSE TAKE ONLY
ONE DOSE .
T. SPIRONOLACTONE – AFTER TAKING DRUG , IF PATIENT MAY
EXPERIENCE DIZZINESS , WEAKNESS IMMEDIATELY, CONSULT PHYSICIAN.
T.PAN 40 – ADVISED TO TAKE DRUG BEFORE ½ HOUR OR AFTER 2 HOURS
OF FOOD
DRUG BASED

21. ANY SUGGESTION LEAVE IN COMMENT
21

22. THANKYOU!
KRISHNAMATHIYARASAN@YAHOO.COM