CASE PRESENTATION ON ACUTE INFECTIOUS HEPATITIS

1. CASE PRESENTATION ON ACUTE
INFECTIOUS HEPATITIS
SUBMITTED BY
METI.BHARATH KUMAR
16DK1T0014
PHARM.D INTERNSHIP

2. SUBJECTIVE INFORMATION
• A 10 years female patient admitted in the pediatrics department unit – II with the
chief complaints of fever,vomitings since 5 days ,abdominal pain and sclera turn
yellow (jaundice) since 2 days.
• PAST HISTORY : No history of similar complaints.
ON ADMISSION:
• WEIGHT : 26 kgs.
• BP:100/60 mm of Hg.
• PR:92/min.
• RR:24/min.

3. OBJECTIVE INFORMATION
History and physical examination:
• History = to determine any risk factors
• Physical examination= gently press down on your abdomen to see if there’s pain or
tenderness also check for any swelling of the liver and any yellow discoloration in your
eyes or skin.
• USG Abdomen : All are normal
• LFT :
• Anti –hepatitis A virus Ig M :9.5
Reference range : negative : < 0.80
Equivocal : 0.80-1.20
Positive : > 1.20

4. ASSESSMENT
• Based on subjective and objective information the case is confirmed as
“ACUTE INFECTIOUS HEPATITIS.”

5. PLAN OF TREATMENT
DAY 1
• PV: N
• BP:100/60 mm of Hg
• Temp : afebrile
• PR:92/min
• RR: 24/min
• CVS: S1S2 +ve
• CNS: Tone
• RS : BAE+
Rx
• 1.inj.cefotaxime 1g IV BD
• 2.T.PCT 500 mg ¾ th PO TID
• 3.ORS
• 4.Syrup.hepamerz 2ml-2ml
• 5.inj.ondansetron 2cc+3cc NS IV
sos
• 6.IVF DNS 500 ml IV TID

6. PLAN OF TREATMENT
DAY 2
• c/o: abd pain
• No c/o : vomitings
• Accepting oral feeds
• O/E
• Vitals stable
• P/A: soft
• Jaundice +
Rx
• 1.inj.cefotaxime 1g IV BD
• 2.T.PCT 500 mg ¾ th PO TID
• 3.ORS
• 4.Syrup.hepamerz 2ml-2ml
• 5.inj.ondansetron 2cc+3cc NS IV
sos
• 6.IVF DNS 500 ml IV TID

7. PLAN OF TREATMENT
DAY 3
• c/o: abd pain
• c/o : vomitings
• Accepting oral feeds
• O/E
• Vitals stable
• P/A: soft
• Jaundice +
Rx
• 1.inj.cefotaxime 1g IV BD
• 2.T.PCT 500 mg ¾ th PO TID
• 3.ORS
• 4.Syrup.hepamerz 2ml-2ml
• 5.inj.ondansetron 2cc+3cc NS IV
sos
• 6.IVF DNS 500 ml IV TID

8. PLAN OF TREATMENT
DAY 4
• c/o: abd pain
• c/o : vomitings
• Accepting oral feeds
• O/E
• Vitals stable
• P/A: soft
• Jaundice +
Rx
• 1.inj.cefotaxime 1g IV BD
• 2.T.PCT 500 mg ¾ th PO TID
• 3.ORS
• 4.Syrup.hepamerz 2ml-2ml
• 5.inj.ondansetron 2cc+3cc NS IV sos
• 6.IVF DNS 500 ml IV TID
• 7.T.urodeoxycholic acid 150 mg BD
• 8.inj.Vit K 5mg IV STAT

9. DRUG CHART
S.NO GENERIC NAME BRAND NAME INDICATION DOSE ROA FREQUENCY
1 cefotaxim Reduce
infection
1g IV BD
2 pantoprazole pantop Reduce
acidity
40 mg IV OD
3 acetaminophen paracetamol Reduce fever 500mg PO SOS
4 Syrup hepamerz Liver
protectant
2 ml PO BD
5 Inj.vitamin k Increase
clotting
factors
5 mg IV STAT
6 Urodeoxycholic
acid
udiliv Reduce
cholesterol in
blood
150 mg PO BD

10. PHARMACEUTICAL CARE ISSUES
• NO pharmaceutical care issues found the prescription was rational.

11. DISCUSSION
• Hepatitis refers to an inflammatory condition of the liver. It is
commonly the result of a viral infection, but there are other possible
causes of hepatitis.
• These include autoimmune hepatitis and hepatitis that occurs as a
secondary result of medications, drugs, toxins, and
alcohol. Autoimmune hepatitis is a disease that occurs when your body
makes antibodies against your liver tissue.
• The five main viral classifications of hepatitis are hepatitis A, B, C, D,
and E. A different virus is responsible for each type of viral hepatitis.

12. TYPES
Type of hepatitis Common route of transmission
hepatitis A exposure to HAV in food or water
hepatitis B
contact with HBV in body fluids, such as blood,
vaginal secretions, or semen
hepatitis C
contact with HCV in body fluids, such as blood,
vaginal secretions, or semen
hepatitis D contact with blood containing HDV
hepatitis E exposure to HEV in food or water

13. CLINICAL MANIFESTATIONS
Common symptoms of infectious hepatitis include:
• fatigue
• flu-like symptoms
• dark urine
• pale stool
• abdominal pain
• loss of appetite
• unexplained weight loss
• yellow skin and eyes, which may be signs of jaundice

14. TREATMENT
• HEPATITIS A: short term illness
resolve naturally
need bed rest
in case of vomitings and diarrhea provide hydration and nutrition.
• HEPATITIS B : treated with anti viral medications
it can be prevented by vaccination, the vaccine can be completed in
6 months of three series of vaccines.
• HEPATITS C : some anti viral drugs.

15. • HEPATITIS D : No specific drugs are available for treatment, a drug called
ALPHA INTERFERON can be used for the treatment of HDV.
• HEPATITIS E: No specific medications ,
it typically resolves on its own.
 adequate rest
 drink plenty of fluids
 get enough nutrients
 avoid alcohol

16. PATIENT COUNSELLING
• Practicing effective hygiene is one way to avoid contracting hepatitis A and E.
• The viruses that cause these conditions can be present in water. you should avoid:
• local water
• ice
• raw or undercooked shellfish and oysters
• raw fruit and vegetables

17. • The hepatitis B, C, and D viruses can transmit through contact with bodily
fluids containing these infectious agents.
• You can reduce your risk coming into contact with fluids containing these
viruses by:
• not sharing needles
• not sharing razors
• not using someone else’s toothbrush
• not touching spilled blood