A 84-year-old male patient was admitted to the hospital complaining of hematuria and burning urination. He has a history of Alzheimer's disease, diabetes, and hypertension. Upon examination, his hemoglobin, ESR, blood glucose, BUN, and creatinine levels were elevated. He was diagnosed with advanced Alzheimer's disease, diabetes, and hematuria. He was treated with antibiotics, antacids, corticosteroids, anti-epileptics, and dopamine agonists. The patient was counseled on medication adherence and signs of worsening condition.

1. A Case Study On Advanced
Alzheimer’s disease
09408103
Pharm.D ( V year)
5-12-2013

2. • A 84 years male patient was admitted in the hospital on 1st
December, 2013.
C/o-Heamaturia since morning
H/o-Burning micturition
K/c/o Diabetes/Hypertension/Cerebral atropy with senile psychosis
PAST MEDICAL HISTORY-Lumbar disc disease (on treatment)
PAST MEDICATION HISTORY-
Donepezil 10 mg
Quitipin 50 mg
PERSONAL HISTORY/SOCIAL HABITS- Non smoker
Non alcoholic
Not a drug abuser
PHYSICAL EXAMINATION-PICCLE(Normal)

3. O/E-
SYSTEMIC EXAMINATION-
TEMP 98.4 F
PULSE RATE 88 /min.
BLOOD PRESSURE 100/70 mm of Hg
RESPIRATORY
RATE
22 breaths/min.
CVS S1 S2 +
RS BAE +
CNS Abnormal
P/A soft

4. • LAB INVESTIGATIONS-
Hb-6.9 g/dl (↓)
RBC-7.5 millions/cu.mm
ESR-20 mm/hr (↑)
PCV-45%
DC-
Total WBC -1o,ooo cells /cu.mm
Neu Lym Eos Mon Bas
60% 30% 6% 3% 1%

5. RBS-145 mg/dl (↑)
BUN-45 mg/dl (↑)
creatininine-1.4 mg/dl (↑)
URINE ANALYSIS-
Appearance- clear
PH- 6
Sugar- Nil
Blood- Present
Bile salts- Nil
Bile pigments- Nil
RBC- Nil
Pus cells- Plenty (↑)

6. DIAGNOSIS-
Advanced Alzheimer’s disease
Type-2 Diabetes mellitus
Hematuria

7. TREATMENT-
DRUG CHART
BRAND GENERIC DOSE ROA FREQUENCY DURATION
INJ.Zanocin Ofloxacin 200mg IV BD 5days
INJ.Rantac Ranitidine 150mg IV BD 5 days
INJ.Avil Pheniramine 1 cc IV OD 3 days
INJ.Decadran Dexamethas-
-one
1 cc IV OD 3 days

8. T.Macorate
CR
Magnesium
valproate
500 mg P/O BD 5days
T.Eptoin Phenytoin 100 mg P/O BD 5 days
T.Levipill Levetiracetam 500 mg P/O OD 5 days
T.Syndopa
plus
Levodopa +
Carbidopa
125 mg P/O BD 5 days
Ciplox eye
drops
Ciprofloxacin 2 drops Opthalmic BD 5 days

9. • DISCHARGE ADVICE-
T.Martifer Nitrofurantoin 100mg 0-0-1 30 days
T.Rantac Rantidine 150
mg
1-0-1 30 days

10. SOAP NOTES-
SUBJECTIVE-
A 84 years male patient was admitted in the hospital
complaining of Hematuria since morning, burning micturition & with
known previously diagnozed case of Alzheimer’s disease.
OBJECTIVE-
Hb-6.9 g/dl (↑)
ESR-20 mm/hr (↑)
RBS-145 mg/dl (↑)
BUN-45 mg/dl (↑)
creatinine-1.4 mg/dl (↑)
Pus cells-plenty (↑)

11. ASSESMENT-
The patient is with a known case of Alzheimer’s disease &
Diabetes mellitus-type 2.
Now the patient is diagnosed with a condition called
‘Hematuria’.
PLAN OF TREATMENT-
The patient is treated with Antibiotics,H2-receptor
antagonists,Corticosteroids,Anti-epileptic drugs & Dopamine agonists.

12. • DRUG INTERACTIONS-
Phenytoin <---------->Levodopa (Significant)
• Phenytoin decreases the effects of Levodopa by unknown
mechanism.
• Monitor closely.

13. PATIENT COUNSELLING-
• Hematuria is not life threatening .
• Improve & maintain the hygienic conditions for the patient.
• Give the medications exactly as prescribed by the physician at the right
time.
• Do not give any OTC drugs or home remedies without consulting the
physician or pharmacist.
• In case of any side effects or serious illness immediately report to the
physician & pharmacist.