CASE PRESENTATION

1. CASE PRESENTATION ON
CHRONIC KIDNEY DISEASE WITH URAEMIC
GASTRITIS
BY:-
KAVIYA AP
PHARM D V Year
RA1522281010017

2. SUBJECTIVE
EVIDENCE Name :- Mr. X
IP No :- 1678095
Age :- 37 years
Gender :- Male
BMI :- 21 (normal)
Department :- General Medicine
Date of Admission :- 15.12.2019
Date of Discharge :- 23.12.2019
PATIENT PROFILE

3. Reason For Admission :-
C/O Fever, dry cough ,abdominal pain x 3days
Breathlessness aggravated during work
Nausea and vomiting
Blood in urine
N/H/C/O Loose stools and burning micturition
Past Medical History :-
K/C/O Diabetes mellitus x 5 years
Hypertension x 5 years
CKD x 2 years
N/K/C/O CAD, CVA, BA

4. Past Medication History:-
T.Furosemide 40mg
T.Nefroguard 150mg x 10 years
T.Glimipiride 1mg
Personal History :-
Mixed diet
BBH altered
Sleep pattern altered
Smoking x 10 years
Alcohol x 10 years

5. GENERAL
EXAMINATION
Physical Examination :-
Temp :- 101.7 F
BP :- 170/100 mm Hg
RR :- 18/cycle
PR :- 112/min
Systemic examination :-
CVS :- S1S2 (+)
CNS :- NFND
RS :- BAE (+)
P/A :-Tenderness +

6. OBJECTIVE EVIDENCE
HEMATOLOGICAL PARAMETERS OBSERVED VALUE NORMAL RANGE
Hb 5.2 11.5-16.5 g/dl
PCV 16 40-50%
Total RBC Count 4.0 4.5-5.5m/cumm
Total WBC Count 13000 4000-11,000/cu.mm
Neutrophils 67 40-80%
Lymphocytes 21 20-40%
Eosinophils 4 1-4%
Basophils 2 0-2%
FBS 260 70-110mg/dl
RBS 240 80-140mg/dl
PPBS 179 80-140mg/dl
HbA1c 7 4.5-6.0%

7. PARAMETERS OBSERVED VALUE NORMAL RANGE
Urea 126 15-40 mg/dl
Creatinine 9.2 0.5-1.2 mg/dl
AST 645 8.0-40 U/L
ALT 692 5.0-35 U/L
BUN 27 7.0-20 mg/dl
Total protein 5.8 6.0-8.3 g/dl
Albumin 3.3 3.5-5.0 g/dl
Globulin 2.5 2.5-3.0 g/dl

8. URINE ANALYSIS RESULTS
Colour Yellow
Appearance Turbid
Albumin ++
Sugar Nil
RBCs Present
Pus cells 12-14
Epithelial cells 5-6
Crystals Nil
Bacteria Nil

9. SPECIAL
INVESTIGATION
CT SCAN of ABDOMEN :
LIVER :
Normal in size and attenuation.
GALL BLADDER :
Normal in size and attenuation. Multiple calculi of 3-4mm are found.
Kidneys :
RK &LK are 6.7x3 cm and 7.7x3.2 cm. Bilateral small size kidneys.
Few cysts are found.
URINARY BLADDER :
Right iliopsoas muscles appears bulky.
Hyperdense collection measuring 8x5.4 cm seen within right iliopsoas muscles.

10. ASSESSMENT
FINAL DIAGNOSIS :
• CKD
• URAEMIC GASTRITIS
• CHOLELITHIASIS

11. PLAN
THERAPEUTIC GOALS :-
 To reduce signs and symptoms.
 To maintain the normal blood pressure level.
 To control patient’s blood sugar level.
 To prevent the progression of the disease.
 To improve the quality of life of patient.

12. MEDICATIONCHART
S.NO DRUG NAME DOSE ROA FREQUENCY DAYS
1. Inj.Amikacin 500mg I.V OD
( Alternate days)
1-7
2. Inj.Meropenam 850mg I.V BD 1-7
3. T.Shelcal 500mg Oral OD 1-7
4. T.Metoprolol 12.5mg Oral BD 1-7
5. T.Clopidogrel 75mg Oral OD 1-7
6. T.Cobadex Oral OD 3-7
7. T.Udiliv 300mg Oral BD 3-7
8. T.Metformin 1000mg Oral OD 1-7
MEDICATIONCHART

13. DRUG INTERACTION
No interactions are found between the drugs.
DRUG-DRUG
INTERACTION

14. PHARMACIST'S
INTERVENTION  Low levels of Hb, PCV and RBC indicating that the
patient is anemic. Multivitamin and iron supplements
should added to improve the condition.
 High level of blood glucose shows patient’s glucose
level is not yet controlled. Hence treatment plan has
to be changed.
 Antiemetics are suggested since patient have
complaints of nausea and vomiting.

15. PATIENTCOUNSELING

16. DISEASE
COUNSELING
1. CKD means the kidneys are damaged and cant
filter the way it should.
2. Most common and serious complication of type
CKD is uremic gastritis.
3. Uremic gastritis is a condition that causes blood
to be introduced into a patient’s urine, due to
gastrointestinal signs and histopathological
changes associated with uremia.
4. Following a healthy diet and modification in
lifestyle of the patient prevent progression of the
disease.

17. DRUG
COUNSELING
1. Follow 4S in drug meditation : Do not share , stop,
skip and sum the doses of the prescribed drugs.
2. A pill organizer or pill container is best way for
medication adherence and keeping alarm can help
patient to take medications at correct time.
3. T.Metformin should be taken after food to avoid
stomach and bowel side effects.
4. Do not intake alcohol with this medication it may
cause dangerous side effects.
5. Do not smoke while taking T.propranolol it makes
the drug ineffective.

18. DIET
COUNSELING
1.Limit foods and drinks that includes saturated fats,high in sodium,
beverages with added sugars.
2.Make every meal well balanced :
The key for eating diabetes is to eat a variety of heathy foods from
all food groups,
Vegetables – Starchy : potatoes , corn.
Non starchy : carrot ,greens, peppers.
Fruits : orange, lemon , berries, bananas.
Grains : wheat , rice ,oats.
Protein : fish , eggs , dried peas.
3.Coconut a week : It maintains blood sugar and A1c and its a good
source of magnesium which may increase insulin sensitivity and
reduce blood sugar level.

19. LIFESTYLE
MODIFICATION
1. Sleep at right time : If amount of sleep decreases, blood sugar
level increases. So sleep for 8-10 hours for normal functioning of
body and also for the production of RBCs.
2. Get body hydrated : Drink enough water to keep body hydrated
and it helps body in eliminating excess of glucose from the body
.
3. Manage stress : when you are stressed or anxious find ways to
relieve – through deep breathing.
4. Candy in a pocket : Whenever there is giddiness , eat a candy
to overcome it.
5. Protect feet : To help prevent foot problems, wear comfortable
and supportive shoes or chappal.

20. REFERENCES :
•www.healthinaging.com
•www.healthline.com
•www.mayoclinic.org
•www.medscape.com
•Clinical pharmacy and therapeutics by Roger Walker
•Pharmacotherapy handbook