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CASE PRESENTATION ONGASTROENTERITIS AND ACUTERENAL FAILUREBY P DEEPAK5th year Pharm D
PATIENT DEMOGRAPHIC DETAILSPATIENT NAME-XYZPATIENT AGE- 42YEARSSEX-FEMALEDATE OF ADMISSION- 11-06-2013
SOAP FOR GASTROENTERITIS
SUBJECTIVE EVIDENCE• C/o several episodes of loose stools since 3days• C/o several episodes of vomiting since one day• H/o...
OBJECTIVE EVIDENCEPathology report:• Stools are semisolid in nature• Mucus present greenish in colour• Entamoeba histolyti...
From subjective and objective evidence, it has been diagnosed as AcuteGastroenteritis.THERAPEUTIC GOALS:Patient specific:-...
Assessment of current therapy-Tab Pantoprazole: 40 mg IV 1-0-1Inj Ondansetron 4mg IV 1-1-1Tab Sporolac 2-2-2Cap Doxycyclin...
TREATMENT CHARTDRUGS DOSEROUTEFREQUENCYDAY1 DAY2 DAY3InjCiprofloxacin100ml IV 1-0-1 + + stopInjMetronidazole100ml IV 1-1-1...
DAY PROGRESS1 C/O6-7 episodes of loose stools ,C/o nausea.No H/o vomiting/abdominal pain.PR:84/min,BP:124/76mm Hg2 Vomitin...
MONITORING PARAMETERS-LABORATORY PARAMETERS-
SOAP FOR ACUTE RENAL FAILURE
SUBJECTIVE EVIDENCE• C/o loose stools and vomiting
OBJECTIVE EVIDENCE• Urea: 73mg %• S. Cr: 3.2 mg%• Cl: 114 mmol/lit• K+: 3.2 mmol/lit• Na+: 144 mol/litUrine analysis:• RBC...
ASSESSMENTFrom subjective and objective evidence, it has beendiagnosed as Acute renal failureTHERAPEUTIC GOALS:Patient spe...
Assessment of current therapy-Tab Pantoprazole: 40 mg IV 1-0-1Inj Ondansetron 4mg IV 1-1-1Tab Sporolac 2-2-2Cap Doxycyclin...
TREATMENT CHARTDRUGS DOSEROUTEFREQUENCYDAY1 DAY2 DAY3InjCiprofloxacin100ml IV 1-0-1 + + stopInjMetronidazole100ml IV 1-1-1...
DAY PROGRESS1 C/O6-7 episodes of loose stools ,C/o nausea.No H/o vomiting/abdominal pain.PR:84/min,BP:124/76mm Hg2 Vomitin...
Patient counseling points• THINGS TO AVOID WHILE RECOVERING:• Alcohol• Caffeine• Dairy products• Citrus products• Fatty, g...
• Food may be offered often in small amounts.Suggested foods include:• Cereals, bread, potatoes, meat• Plain yogurt, banan...
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Case presentation on gastroenteritis and acute renal failure

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Case presentation on gastroenteritis and acute renal failure

  1. 1. CASE PRESENTATION ONGASTROENTERITIS AND ACUTERENAL FAILUREBY P DEEPAK5th year Pharm D
  2. 2. PATIENT DEMOGRAPHIC DETAILSPATIENT NAME-XYZPATIENT AGE- 42YEARSSEX-FEMALEDATE OF ADMISSION- 11-06-2013
  3. 3. SOAP FOR GASTROENTERITIS
  4. 4. SUBJECTIVE EVIDENCE• C/o several episodes of loose stools since 3days• C/o several episodes of vomiting since one day• H/o spasmodic type of abdominal pain
  5. 5. OBJECTIVE EVIDENCEPathology report:• Stools are semisolid in nature• Mucus present greenish in colour• Entamoeba histolytica cyst seen• N: 83%(40-75%)• L: 10%
  6. 6. From subjective and objective evidence, it has been diagnosed as AcuteGastroenteritis.THERAPEUTIC GOALS:Patient specific:- To prevent dehydration by making sure the body has enoughwater and fluids.Disease specific:- to prevent recurrence of diseaseASSESSMENT:
  7. 7. Assessment of current therapy-Tab Pantoprazole: 40 mg IV 1-0-1Inj Ondansetron 4mg IV 1-1-1Tab Sporolac 2-2-2Cap Doxycycline 300mg statInj Ciprofloxacin 100ml IV 1-0-1
  8. 8. TREATMENT CHARTDRUGS DOSEROUTEFREQUENCYDAY1 DAY2 DAY3InjCiprofloxacin100ml IV 1-0-1 + + stopInjMetronidazole100ml IV 1-1-1 + + stopInj Pantoprazole 40mg IV 1-0-1 + + TabPantoprazoleInj Ondansatron 4mg IV 1-1-1 + + 1-0-0/sosT Sporolac 2-2-2 + + +T Racecadotril 100mgP.O 1-1-1 + + +CapDoxycycline300mgP.O stat + stop
  9. 9. DAY PROGRESS1 C/O6-7 episodes of loose stools ,C/o nausea.No H/o vomiting/abdominal pain.PR:84/min,BP:124/76mm Hg2 Vomitings and loose stools reduced ,No abdominal pain,BP: 124/76mm Hg,PR: 82 bpm4 Patient comfortablePROGRESS CHART
  10. 10. MONITORING PARAMETERS-LABORATORY PARAMETERS-
  11. 11. SOAP FOR ACUTE RENAL FAILURE
  12. 12. SUBJECTIVE EVIDENCE• C/o loose stools and vomiting
  13. 13. OBJECTIVE EVIDENCE• Urea: 73mg %• S. Cr: 3.2 mg%• Cl: 114 mmol/lit• K+: 3.2 mmol/lit• Na+: 144 mol/litUrine analysis:• RBC: 1-2/hpf• Pus cells: 2-4/hpf• Alb : traces• Epithelial cells: 4-6/hpf• Stools: semisolid containing greenish mucus• Entamoeba cyst seen
  14. 14. ASSESSMENTFrom subjective and objective evidence, it has beendiagnosed as Acute renal failureTHERAPEUTIC GOALS:Patient specific:- To prevent dehydration bymaking sure the body has enough water andfluids.Disease specific:- to prevent recurrence of disease
  15. 15. Assessment of current therapy-Tab Pantoprazole: 40 mg IV 1-0-1Inj Ondansetron 4mg IV 1-1-1Tab Sporolac 2-2-2Cap Doxycycline 300mg statInj Ciprofloxacin 100ml IV 1-0-1
  16. 16. TREATMENT CHARTDRUGS DOSEROUTEFREQUENCYDAY1 DAY2 DAY3InjCiprofloxacin100ml IV 1-0-1 + + stopInjMetronidazole100ml IV 1-1-1 + + stopInj Pantoprazole 40mg IV 1-0-1 + + TabPantoprazoleInj Ondansatron 4mg IV 1-1-1 + + 1-0-0/sosT Sporolac 2-2-2 + + +T Racecadotril 100mgP.O 1-1-1 + + +CapDoxycycline300mgP.O stat + stop
  17. 17. DAY PROGRESS1 C/O6-7 episodes of loose stools ,C/o nausea.No H/o vomiting/abdominal pain.PR:84/min,BP:124/76mm Hg2 Vomitings and loose stools reduced ,No abdominal pain,BP: 124/76mm Hg,PR: 82 bpm4 Patient comfortablePROGRESS CHART
  18. 18. Patient counseling points• THINGS TO AVOID WHILE RECOVERING:• Alcohol• Caffeine• Dairy products• Citrus products• Fatty, greasy and/or fried foods• Raw fruits and vegetables• Aspirin• Ibuprofen
  19. 19. • Food may be offered often in small amounts.Suggested foods include:• Cereals, bread, potatoes, meat• Plain yogurt, bananas, fresh apples• Vegetables

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