It may serve the academic needs of medical & pharmacy students

1. Case study on Acute Renal
Failure
21-02-14

2. • Name: X Age: 63 Sex: Male
DOA: 25/6/12 DOD: 30/6/12
• Chief complaints: C/O abdominal distension and puffy face with
C/O severe head ache.
• H/O fever with breathing difficulty X 5 days.
• Lower limb swelling X 1 month.
• H/O occasional Seizures X 2 days.
• Past medical history:
K/C/O HTN, DM X 20 years.
K/C/O Renal calculi.

3. • Past medication history:
Diltiazem – 30mg, Insulin, Metformin – 500mg
• Personal/Social history:
Alcoholic, smoker, Married.
• On examination:
• Physical examination:
Conscious/Oriented/Oedema.
Temp: 100.1ºF Pulse: 82 beats/min.
BP: 160/120 mm/Hg.
• System examination:
• CVS: S1S2+ RS: BAE(-), Wheezing+
• CNS: NFND ABD: Ascites+

4. Lab investigations
Haemoglobin 10.4g/dl 14-18g/dl
Platelet 130 x 10mm3 150-400
Blood sugar
FBS 250mg/dl 70 to 110mg/dl
Rbs 385 80-110mg/dl
PPBS 340 Less than 180mg/dl
RENAL
BUN 58g/dl 8-23mg/dl
Cr 2.8g/dl 0.6-1.2mg/dl
Na 130mmol/l 135 - 145 mmol/liter
K 4.5mmol/l 3.5 - 5.0mmol/l
Cl 94mmol/l 98 - 108 mmol/L.
Bicarb 23mmol/l 22-30mmol/L.

5. Urine analysis
Color Clear yellow
pH 6.5
Sugar Trace
Protein 84mg/dl 60-140mg/dl
ESR 20 – ½ hr 5-15mm
Diagnosis: Acute renal failure, Diabetic nephropathy, Systemic HTN, DM - II

6. DRUG CHART
DRUGS ROA DOSE DOSAGE No.OF DAYS
Inj.FUROSEMIDE IV 60mg OD X 5 days
Inj. PANTOPRAZOLE IV 40mg BD X 5 days
Neb. BUDESONIDE P/N 0.5mg Stat X 2days
T. DILTIAZEM P/O 30mg OD X 5 days
T. CLOPIDROGEL P/O 75mg OD X 5 days
T. SUPRDAYN P/O 100mg OD X 5 days
T. LEVOCETRIZINE P/O 5mg OD X 3 days
Neb. IPRATROPIUM
BROMIDE +
SALBUTAMOL
P/N 500mcg/
2.5mg
Stat X 3 days
T. GLIMEPIRIDE P/O 2mg OD X 5 days
T. METFORMIN P/O 500mg BD X 5 days
INJ. FOSPHENYTOIN IV 5U BD X 5 days

7. Discharge advice
• T. FUROSEMIDE - 40mg (OD)
• T.CLOPIDROGEL - 75mg (BD)
• T. METFORMIN – 250mg ( BD)
• Drug interactions:
• Budesonide vs Clopidrogel vs Fosphenytoin
• Budesonide will decrease the level of of clopidrogel by
affecting/intestinal enzyme CYP3A4
metabolism.(significant-monitor closely)