case studies

1. CASE PRESENTATION ON VIRAL
HEPATITIS -B
PRESENTED BY :Aryan shah
PHARMD 3rd year
Department Of Clinical pharmacy

2. PATIENT DEMOGRAPHIC
DETAILS:
Name: XYZ DOA: 01/06/2017
Age : 60yr DOD: 07/06/2017
Sex : Female Unit : A (Med)
Complaints on Admission:
C/O : Generalized weakness,
Loss of appetite since 15 days.

3. PAST MEDICAL HISTORY:
 Patient was apparently normal 15 days
back. She developed generalized
weakness of body and loss of appetite
gradually onset, progressive in nature
 H/O Dyspepsia and Breathlessness .

4. SOAP Analysis:
 S- Subjective findings
 O- Objective findings
 A- Assessment
 P- Planning

5. Subjective findings:
 C/o Generalized weakness,
 C/o Loss of appetite since 15 days,

6. Objective findings:
Icterus and clubbing is positive.
 Lab data:
HbSag : +ve
Bilirubin: T: 14.6 mg% (0.2 to 1.0 mg%)
D: 7.6 mg % (0.1 to 0.4 mg%)
I : 7.0 mg% (0.2 to 0.7 mg%)
 SGOT : 134 IU/L (5 to 40 IU/L)
 SGPT : 110 IU/L (5 to 35 IU/L)
 Total Protein: 8.6 gm%(5 to 8 gm%)
Albumin: 4.4 gm% (3.5 to 5.5 gm%)
Globulin: 4.2 gm% (1.5 to 3 gm % )
Hb:10gm%

7. Assessment:
From the subjective and objective evidence it
is confirmed that the patient is suffering
from VIRAL HEPATITIS - B.
PROBLEM LIST : VIRAL HEPATITIS - B

8. GOALS
Patient Specific:
 To relieve generalized weakness of body
,loss of appetite.
Disease Specific:
 To eradicate Hepatitis B Virus.
 To prevent long term complications like
cirrhosis, liver failure and hepatocellular
carcinoma.

9. Assessment of current therapy
Date Generic
name
dose frequenc
y
indication route time End date
1-6-017 Dextrose
25%
100ml 1-1-1 Maintian blood
glucose
IV 7-6-017
1-6-017 Vitamin K 10mg 1-0-1 Vitamin
supplement
IV 3-6-017
1-6-017 Ciprofloxaci
n
100mg 1-0-1 Antibiotic IV 7-6-017
1-6-017 Silymarin 70mg 1-0-1 Ayurvedic for
liver disease
PO A/F 7-6-017
1-6-017 Lamivudine 100mg 0-1-0 antiviral PO A/F 7-6-017
1-6-017 pantoprazol
e
40mg 1-0-o PPI IV 7-6-017
1-6-017 Ursidiol 300mg 1-0-1 Dissolve gall
stones
PO A/F 7-6-017
4-6-017 Syp lactose 3.35mg/
5ml
1-1-1 constipation PO A/F 7-6-017

10. Progress Chart:
 Day 1: No fresh compliant, B.P: 110/70 mm of Hg, PR: 90bpm
 Day 2 : Nausea, Vomiting, PR: 88 bpm
 Day 3 : Nausea, B.P: 110/76 mm of Hg,
 Day 4 : Nausea, PR: 88bpm, B.P: 114/72 mm of Hg
 Day 5: No fresh compliant. PR: 82 bpm, B.P: 118/78mm Hg.

11. PLANNING :
Discharge medications:
 Tab Lamivudine 100mg ………….1year …. (1-
0-0)
 Tab Silymarin 70mg …………….10 days .. (0-
1-0)
 Tab Pantoprazole 40mg …………10 days .. (1-
0-0)
 Tab Ursodiol 300mg ………….. 10 days…(1-
1-1)

12. Monitoring parameters:
Therapeutic parameters:
Liver Function Tests.
Monitor for bone marrow toxicity with frequent blood count.
Adverse drug reactions:
Lamivudin: Headache, Insomnia, Anemia, Myopathy, Fever,
Chills,
Cough, Nausea, Vomiting, Abdominal pain, Cramps,
Ursodiol: Constipation, Vomiting, Cough, Dyspepsia.
Silymarin : Sweating, Nausea, Vomiting, Abdominal pain,
Diarrhea.
Pantoprazole: Migraine, Headache, Abnormal liver function.

13. Patient Counseling:
• Warn patient to report abdominal pain immediately.
• Advise patient to consult his doctor before taking other medicine.
• Abstain from alcohol and avoid OTC drugs or supplements that may be
hepatotoxic (e.g., high doses of acetaminophen).
• Use of barrier contraceptive methods .
• Immunization against HBV also plays a key role in primary prevention of
HBV infection, and hepatitis B vaccination has to be done.
Avoid the Spread of Hepatitis B
• All parents, siblings, and other household members should be vaccinated.
Extended family members, childcare providers, family, friends, and others
should consider vaccination if they have, frequent and close contact with
your child.