A case study on Post partum depression with CVT.

1. Case study presentation
Post partum depression with CVT

2. A 28 y/o female is admitted to the hospital post delivery
for post partum depression. The chief complaints as
described by the patient representative are as follows:
• Doesn't feed the baby
• Doesn't accept him
• Doesn't speak and refuses to eat at all

3. OBJECTIVE DATA
• Medical h/o: NA
• Medication h/o: NA
• Previous allergies: NS
• Family h/o:NS
• Social h/o: NS

4. P/E
1. General condition: moderate
2. Vitals: BP 110/80 on admission, fluctuations variantly
3. CVS : S1S2, no murmur
4. CNS: conscious, oriented
5. P/A: S/NT
6. HEENT: N
7. RS: AEEBS clear

5. Haematology
• Hb 10.8
• RBC: 3.32mill/cc
• MCV: 97.6 FL
• MCH: 31
• Neut: 77%
• Lym: 16%
• PLT: 5070000
•
Routine examination
• D.Bil: 0.2
• T.Bil: 0.8
• SGPT: 30.7
• SGOT: 44.54
• ALP: 84.9
• T Pr: 65
• Alb: 2.9
• Glo: 3.6
• BUN: 19.3
• S.Na: 139 mEq/L
• S.K: 4.3 mEq/L
Lab investigations

6. ASSESSMENT
• Diagnosis: postpartum depression with
CVT
• Etiology : hypercoagulabity post natal
• Goal of therapy: improve quality of
living and prevent complications

7. LEVIPIL 10mg/ day OD(Levitaracetam)
 Indications: Partial onset seizures, myoclonic seizures,
Primary GTC seizure
 Dosage: Adults- 20mg/day
 Precautions: pregnancy category C, not recommended for
nursing mother
 ADR: Somnolence, depression, ataxias

8. BEVOCEF 10 mg BD ( CEFIXIME TRIHYDRATE)
 MOA: third generation cephalosporin, effective against wide spectrum of
bacterias. Inhibits cell wall synthesis
 Indications: infections in urinary, respiratory tract
 Dosage: 200-400 my/ day
 CI: Hypersensitivity
 Precaution: use with caution in pregnancy and lactation
 ADR: GI dist, headache, rashes
 DI: Probenacid, Aspirin

9. PANTOP 40 mg OD (Pantoprazole)
 It inhibits parietal cells' H,K ATPase which secretes HCl
 Indications: ulcers and reflex oesophagitis
 Dosage: 40-80 mg/day
 CI: Hypersensitivity
 ADR: headache, diarrhea, dizziness

10. EMESET 4g iv TDS ( ONDANSETRON)
Highly selective 5HT3 antagonist
 Indications: Nausea, vomiting
 CI: Hypersensitivity
 ADR: Headache, constipation, allergies
 DI: Dexamethasone

11. ENCLEX 40 mg OD ( ENOXAPARIN )
LMW Heparin analog, inhibits thrombin and increases clotting time.
 Indications: prevention deep vein thrombosis
 Dosage: 20-40 mg sc
 CI: hemorrhage, septic endocarditis
 Precautions: hepatitic insufficiency, pregnancy and lactation
 DI: oral anticoagulants, NSAIDs

12. WARFARIN SODIUM 10 mg BD
Warfarin depletes functional vitamin K reserves, which in turn reduces
synthesis of active clotting factors
 Indications: Thrombosis, stroke and thromboembolism
 CI: pregnancy, malignant hypertension
 Dosage: 10- 20 mg/day
 ADR: intraocular hemorhage, Pruritis, abdominal pain
 DI: Aspirin, Mifepristone, Estradiol

13. MANNITOL 10%
It is a diuretic and a centrally acting osmotic agent. It reverses
depolarization caused by Na+ in open state.
 Indications: cerebral edema, anuria, broncheictasis
 Cl:Hypersensitivity, anuria, severe pulmonary edema
 ADR: CHF, hypotension, angina
 DI: tobramycin, nitroglycerin

14. PLANNING
• Therapeutic monitoring: PLT count,
BP
• Discharge medicine: patient not
discharged
• Toxicity monitoring: warfarin,
mannitol, levipil

18. Point to patient
• About the disorder: CVT is due to
hypercoagulabity post natal
• About medications: Take medications
regularly as prescribed
• Lifestyle modifications: A proper balanced
diet and adequate rest is important

19. POINT TO PHYSICIAN
• Levitaracetam is the possible cause of depression in
the patient and should be withdrawn immediately,
since the patient has no seizures as well. Prescribe
drug for depression.
• The PLT count of pt. is relatively high. Dose of
anticoagulants to be reduced or a single drug
recommended.
• CT Scan of brain and MRI should be done
• Advise the patient is for appropriate therapy and
counselling sessions
• The dosing of anticougalants should be monitored
closely and adjusted accordingly

20. THANK YOU