Case presentation on sepsis with peritonitis

1. CASE PRESENTATION ONCASE PRESENTATION ON
SEPSIS WITH PERITONITISSEPSIS WITH PERITONITIS
BY
D.HIMAJA
14Z91T0004

2. PATIENT DEMOGRAPHIC DETAILSPATIENT DEMOGRAPHIC DETAILS
Name - Sarayu
Age - 2 years
Gender - female
Weight - 10kgs
Height - 76 cms
Ip number - 18003691
Department -paediatrics
Date of admission – 12 /12/18
Date of discharge - 22/12/18

3. SOAP ANALYSISSOAP ANALYSIS

4. SUBJECTIVE EVIDENCESUBJECTIVE EVIDENCE
c/o-vomiting,seizures, loose stools since
7 days.
Past medical history:-right sided VP
shunt with ependymoma.
Past surgical history:- operted for
tethered cord syndrome. Pateint
developed status epilepticus associated
with fever.

5. On examination:-On examination:-
Child is sleeping , afebrile
Abdomen –soft
CNS tone-normal on painful stimuli
CVS - s₁s₂ heard
Breath sounds-clear
Lungs – bilateral air entry.

6. VITALS:-VITALS:-
Pulse rate-86/min
Respiratory rate-24/min
Spo₂ - 99%
Temperature – 98.7°F
Preliminary diagnosis:- hydrocephalus
with bilateral VP shunt ? Peritonitis.

7. OBJECTIVEOBJECTIVE
EVIDENCEEVIDENCE

8. CT brain- hydrocephalus .
USG- Gall bladder –well distended
urinary bladder-empty with folings bulb.
Uterus-Mild IU free fluid with multiple thin
echogenic septation.
MRI- infected epidermoid cyst-dorsal
dermal sinus extending spinal cord at
s₂₋₃lever. Extensive lepto meningitis

9. ASSESSMENTASSESSMENT
From the subjective and objective
findings the child is diagnosed with
sepsis with peritonitis and spastic
paraparesis.

10. DRUG CHARTDRUG CHART
DRUG NAME GENERIC
NAME
DOSE ROUT
E
FREQU
ENCY
1 2 3 4 5 6 7 8 9 10
Isolyte Iv fluids 700ml IV OD + + + + + - - - - --
Taxim Cefixime 250mg IV BD + + + + + + + + + +
Amikacin Amikacin 25mg IV BD + + + + + + + + + +
Levipil Levitriacet
am
20 mg IV BD + + + + + + + + + +
Encorate Sod.
valproate
20 ml IV BD + + + + + + + + + +
Mannitol Mannitol 20ml IV TID + + + + + + + + + +
Lorazepam Lorzepam 10mg IV BD - - - + + + + + + +
Phenytoin Phenytoin 20 mg IV OD - - - - - - + + + +
Cefotaxim Cefotaxim 1 gm IV BD + + + + + - - + + +

11. DRUG NAME GENERIC
NAME
DOSE ROUT
E
FREQU
ENCY
1 2 3 4 5 6 7 8 9 10
Rantac Ranitidine 150mg IV BD - - + + + + + + + +
Ceftriaxone Ceftriaxone 350mg IV BD + + + + + - - - - -
Zofer Ondansetron 2mg IV BD - + + + + + + + + +
Lorazepam Lorazepam 0.7mg IV SOS - - - + + + + + + +
Paracetamol Paracetamol 4 ml oral SOS + + + + + + + + + +
Metrogyl Metronidazol
e
50 mg IV TID - - - - - + + + + +
Meropenem Meropenem 10mg IV BD + + + + + + + + + +
targocid Teicoplanin 70mg IV OD + + + + + + + + + +

12. PHARMACIST INTERVENTIONPHARMACIST INTERVENTION
Therapeutic duplication found I this
prescription :-
Lorazepam a benzodiazepine derivative
drug has been given to the patient in two
different doses i.e, (1mg and 0.7 mg)

13. DRUG INTERACTIONSDRUG INTERACTIONS
 Three major drug- drug interactions were found
in this prescription.
Valproic acid + meropenem
Meropenem decreases levels of valproic acid
by unknown mechanism. Avoid or Use Alternate
Drug. Risk of seizure. Possible decreased GI
absorption and/or increased renal clearance of
valproic acid

14. Amikacin + mannitol
 Co administration of parenteral or inhaled
aminoglycoside antibiotics or oral neomycin in
combination with loop diuretics may potentiate the risk
of oto- or nephrotoxicity due to additive or synergistic
pharmacologic effects of these drugs and or altered
aminoglycoside serum and tissue levels
Amikacin + Teicoplanin
Amikacin and teicoplanin both increase nephrotoxicity
and/or oto toxicity. Avoid or Use Alternate Drug

15. DISCHARGE MEDICATIONSDISCHARGE MEDICATIONS
Syp. Paracetamol 4ml oral sos - 15 days
Inj.rantac 50 mg iv od - 15 days
Tab metrogyl 50 mg oral od - 15 days
Tab ceftriaxone 350mg oral od - 15 days
Tab ondansetron 2 mg oral od - 15 days
Tab phenytoin 10 mg oral od - 15 days
 Review after 15 days in op department

16. PATIENT COUNSELLINGPATIENT COUNSELLING
 Ketogenic diet consisting of relatively low
carbohydrate and adequate protein with high
fats content is to be recommended under the
supervision of dietician .
 Encourage the child to sleep well and take
medications on time .
 Care during seizures allow the saliva secretions
to drain or vomit and do not stop child
movements or convulsions.
 If seizures lasts longer than 5 min seek
immediate treatment.