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CASE PRESENTATION ON DRUG INDUCED GASTROINTESTINAL BLEED.pptx

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CASE PRESENTATION ON DRUG INDUCED GASTROINTESTINAL BLEED.pptx

  1. 1. CASE PRESENTATION ON DRUG INDUCED GASTROINTESTINAL BLEED PRESENTATION BY: SIDDIQUA PARVEEN
  2. 2. PATIENT DETAILS: IP No: 8374 Age: 87 years Gender: Male Department: Internal medicine Conultant name: Dr. T N J Rajesh Date of admission: 11/9/22
  3. 3. SOAP NOTES SUBJECTIVE EVIDENCE: CHIEF COMPLAINTS: 3 episodes of black colored vomitings since 2-3 days, 1 episode of black color stool since 2 days accompanied with loss of appetite and generalised weakness. No stool passage yesterday.Aphasia since 2-3 days. MEDICALAND MEDICATION HISTORY: Hypertension – On TELMA40mg OD Diabetes mellitus – On Janumet 50/500mg OD Hemiarthroplasty On Ecosprin 75mg OD
  4. 4. OBJECTIVE EVIDENCE AND ASSESSMENT: 1. Accelerated Hypertension – constantly elevated blood pressure 2. Upper GI bleed – drug induced due to long term usage of ecosprin CT SCANABDOMEN: Mild bilateral perinephric fat stranding Oesophageal and gastric ulcers Evidence of large hiatus hernia, faecal loaded colon Mild pleural effusion noted on right side 12/922 13/9/22 14/9/22 15/9/22 16/9/22 17/9/22 VITALS BP(mmHg) 160/90 180/80 163/75 160/70 140/70 140/60 HR(bpm) 78 95 99 99 98 90 Spo2(%) 96 95 99 99 98 98
  5. 5. 3. Hypertensive encephalopathy – due to high blood pressure characterised by mental status changes CT SCAN BRAIN: Bilateral chronic hypertensive ischemic encephalopathic changes Age related atrophy EEG: Grade II encephalopathy Glasgow coma scale: 12/9/22 13/9/22 E4V4M6 E4V5M5
  6. 6. 4. UTI (Urosepsis) – based on findings in CUE and sepsis profile URINE EXAMINATION: RBC: 6-10 hpf PUS CELLS: plenty PROTIEN: 2+ CULTURE SENSITIVITY TEST: Urine (aerobic) – E Coli (ESBL negative) SEPSIS: 12/9/22 13/9/22 14/9/22 15/9/22 Temperature Afebrile 98.6 98 Low TLC 6.4 7.7 10.2 5.9 CRP 27 61 185 Microbiology - Magnex forte Magnex forte Blood – SFNG Urine - Ecoli
  7. 7. 5. AKI – due to decreased urine output 6. Hypokalemia – based on K+ levels 12/922 13/9/22 14/9/22 15/9/22 16/9/22 17/9/22 Potassium 4.1 4.4 4.2 3.6 3.0 3.4
  8. 8. . 12/9/22 13/9/22 14/9/22 15/9/22 16/9/22 17/9/22 BLOOD SUGAR LEVELS (mg/dl) FBS (7am) 151 126 128 145 118 107 PPBS (1pm) 132 135 111 127 118 141 RBS (7pm) 136 102 131 139 URINE OUTPUT (ml/hr) 90 80 60 50
  9. 9. CULTURE REPORTS: Sputum culture: Normal flora Blood culture: SFNG Urine culture: SFNG Urine (aerobic) – E Coli Resistant – cotrimoxazole, ciprofloxacin, levofloxacin Sensitive – amikacin, gentamicin, imipenem, magnex forte, tazact, meropenem, ertapenem, nitrofurantoin, cefuroxime, ceftazidime
  10. 10. PLAN: 12/9/22 1.On examination patient BP was high so Tab Amlong 10mg OD started 2.IV NS 200+100ml bolus @80ml/hr, Inj PAN infusion @8ml/hr, Inj Magnex forte 1.5gm IV BD, Syp Sucralfate 10ml q6h was started initially as the patient was suffering from vomitings 3.CT abdomen, CT brain, 2D echo and EEG investigations to be done
  11. 11. 13/9/22 1.Patient taken to endoscopy with decreased sedation. During the procedure vitals were BP-220/112mmHg, PR-156bpm, Spo2-90% Treatment: Intubated with LMA and controlled ventilation done and nitroglycerin infusion started Then the vitals were BP-177/89mmHg, PR- 108bpm, Spo2-100% (facemask O2@4l/min) *Continue treatment as per chart
  12. 12. 14/9/22 1.RTF after confirming RT position 2.Continue pan infusion and sucralfate syrup 3.Start RT feed 50ml/hr (formula: critipro DM – 6 scoops in 150ml water and make upto 200ml) 4.Patient complained of cough with expectoration *Continue rest treatment as per chart
  13. 13. 15/9/22 1.Urine culture – Ecoli (ESBL negative), so magnex forte is escalated to meropenem 2.Restart Bactrim DS 3.Continue RT feed @50ml/hr 16/9/22 *Continue treatment as per chart *Monitor vitals
  14. 14. MEDICATION CHART MEDICATION DOSE ROUTE FREQUENCY START DATE Inj Magnex Forte 1.5g IV BD 12/9/22 Inj Thiamine 2amp IV BD 12/9/22 Inj Optineuron 2amp IV OD 12/9/22 T. Cinod 10mg RT OD 12/9/22 Enema BD 12/9/22 Syp Sucralfate 10ml PO TID 12/9/22 T. Bactrim DS 1 tab PO BD 12/9/22 Syp Lactihep 15ml PO TID 13/9/22 T. Mucinac 600mg PO BD 14/9/22 Inj Meropenem 1g IV TID 15/9/22 Syp Potklor 15ml RT QID 16/9/22
  15. 15. INTERVENTIONS: 1.Inappropriate medical history 2.Haemoglobin levels decreased 3.Bactrim DS (Urine culture reports show E Coli resistant to trimethoprim/ sulphamethoxazole) 4.Hiatus hernia
  16. 16. THANKYOU

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