The document details a case analysis of a 27-year-old female with chronic kidney disease and meningitis, who exhibited symptoms including dizziness, breathing difficulties, and seizures. Vital signs and lab data reveal significant abnormalities such as high potassium and creatinine levels, prompting a complex medication regimen. The treatment plan includes multiple medications for hypertension, seizures, and infection management, along with counseling on diet and lifestyle modifications.

1. CASE ANALYSIS
PRESENTED BY ALIDA VINS VS
FIFTH PHARM D

2. SUBJECTIVE
Mrs. Denisha, a 27 year old female was
admitted in the general ward with chief
complaints of dizziness, headache,
breathing difficulty and two episodes of
seizure.

3. OBJECTIVE
1.Vital signs
PR:102 b/min
RR:22 b/min
BP:190/110 mmHg
T: 98.6 degree F

4. 2.Lab data
a) Abnormal findings
BLOOD BIOCHEMICAL
ESTIMATIONS
DATE PARAMETER OBSERVE
D VALUE
INTERPRETATION
29/11/19 POTASSIUM 7.10mg/dl Chronic kidney Disease (CKD)
30/11/19 POTASSIUM 6.0mg/dl CKD
CSF SUGAR 58.00mg/10
0ml
Meningitis, Seizure.
CSF
PROTEIN
87.00mg/dl Meningitis, Seizures.
01/12/19 POTASSIUM 7.5mg/dl CKD

5. 2/12/19 UREA BLOOD 87.00 mg/dl CKD
CREATININE
SERUM
10.7 mg/dl CKD
SODIUM 139 mg/dl CKD, HTN
3/12/19 SODIUM 139 mg/dl CKD, HTN
CREATININE
SERUM
8.30 mg/dl CKD
b) Normal findings
Other lab datas were found to be normal.

6. 4.Other investigations
a) Urine analysis
Albumin: +++
Sugar: Present
PUS cells: 2.5 HPF
b)Microbiology
Smear for acid fast bacteria from CSF specimen -
Streptococcus Pneumonia
5.Past medical history
a)Co morbidities: Hypertension (HTN)
b)Social Habits: Not Known
6.Diagnosis
Meningitis
Chronic Kidney Disease (CKD)

7. 7) Present medication
DRUG DAY
1
DAY
2
DAY
3
DAY
4
DAY
5
DAY
6
DAY
7
DAY
8
INDICATION
T.Amlong         Antihypertensive
T.Hasurge         Vitamin
supplement
T.Pantocid         Acid suppression
T.Atorax        Decrease brain
activity
T.Revlamer     CKD
INJ.Epotrust  CKD
INJ.Calcium
gluconate
    CKD
INJ.Dextros
e
    Caloric
supplement
NEB.Asthali
n
  Breathing difficulty

8. Potassium bind
Sachet
    CKD
INJ.Taxim    Meningitis
INJ.Valparin
Chrono
  Seizure
T.Atorva        Prophylaxis to
cholesterol
T.Dolo  Fever
T.Epilex Chrono      Seizure
T.Levacetam        Seizure
INJ.Piptaz    Prophylaxis to
Bacterial
infection
INJ.CP       Meningitis
T.Sevalmer       CKD

9. PROGRESS
TEMP
(degree F)
PR(beats/
min)
RR(beats
/min)
BP
(mmHg)
FBS
(mg/dl)
I 0 (ml)
DAY 1 98.6 102 22 190/110 --- ---
DAY 2 100.2 102 24 150/90 48 2000/200
DAY 3 98 78 20 150/80 118 2000/200
DAY 4 98.6 100 20 110/80 132 2100/200
DAY 5 98.6 70 22 150/80 70 1200/600
DAY 6 98.6 94 20 160/100 158 1500/400
DAY 7 98.6 82 22 160/100 150 1500/600
DAY 8 98.6 78 22 180/100 --- 195/750

10. PRESCRIPTION ANALYSIS
DRUG FREQUENCY CATEGORY INDICATION
T.Amlong 5mg
(Amlodipine)
1-0-1 P/O Antihypertensive
agent
Due to high blood
pressure
T.Hasurge 1-0-1 P/O Vitamin
supplement
Vitamin deficiency
T.Pantocid 40mg
(Pantoprazole)
1-0-0 P/O Proton pump
inhibitor
To suppress acidity
in stomach
T.Atorax 10mg
(Hydroxyzine)
0-0-1P/O Antihistamine To decrease brain
activity and relax
T.Revlamer 400mg 1-1-1 P/O Phosphate
binders
Due to CKD
INJ.Epotrust 2000IU
(Erythropoetin)
3/7 Erythropoesis
stimulating agents
To prohibit anemia
due to CKD
INJ.Calcium
gluconate 10ml
Q8H IV Mineral
supplement
To treat high
potassium level in
blood
INJ. 25%Dextrose
100ml 100 H.A
Q8H IV Fluid Replenisher For Dizziness and
Hypoglycemia
NEB.Asthalin Q4H Beta 2 adrenergic To reduce Breathing

11. Potassium bind sachet
15g
1-1-1 P/O Potassium binder Due to high
potassium level.
INJ.Taxim 1g
(Cefotaxim)
BD IV Cephalosporin
Antibiotic
To treat Meningitis
INJ.Valparin Chrono
300mg (Valproic acid)
1-0-0 IV Antiepileptic drug To treat episodes of
seizures
T.Atorva 10mg
(Atorvastatin)
0-0-1 P/O HMG-CoA
redcuctase
inhibitor
Prophylaxis to
cholesterol
T.Dolo 650mg
(Acetaminophen)
SOS P/O Antipyretic agent To treat fever
T.Epilex Chrono 300mg
(Valporate)
1-0-1 P/O Antiepileptic drug To treat Seizure
T.Levacetam 500mg
(Levetiracetam)
0-0-1 P/O Antiepileptic drug To treat Seizure
INJ.Piptaz 4.5g
(Piperacillin+Tazobacta
m)
BD Penicillin Antibiotic To treat meningitis
INJ.CP 20lakh
(Benzyl penicillin)
Q6H IV Penicillin Antibiotic To treat meningitis
T.Sevalmer 400mg 1-1-1 P/O Phosphate binders Due to CKD

12. DRUG INTERACTION
No severe Drug-Drug interactions were
found.

13. ASSESMENT
 DIAGNOSIS
Meningitis
Chronic Kidney Disease on HD
 COMORBIDITIES
Hypertension (HTN)
 ALLERGIES
Nil

14. PLAN
SL
NO
DRUG & DOSE REASON FOR CHANGE / ADDITION
1. T.Amlong 5mg 1-0-1 No change
2. T.Hasurge No change
3. T.Pantocid 40mg 1-0-1 P/O No change
4. T.Atorax 10mg 0-0-1 P/O No change
5. INJ.Revalmer 400mg 1-1-1
P/O
No change
6. INJ.Epotrust 2000 IU 3/7 No change
7. INJ.Calcium gluconate 10ml
Q8H IV
No change
8. INJ.Dextrose 100ml 100HA No change
9. NEB Asthalin Q4H No change
10. Potassium bind sachet 15g 1-
1-1
No change
11. INJ.Taxim 1g BD IV No change
12. INJ.Valparin Chrono 300mg
1-0-0
No change

15. 14. T.Dolo 650mg SOS P/O No change
15. T.Epilex Chrono 300mg 1-0-1
P/O
No change
16. T.Levacetam 500mg 0-0-1 P/O No change
17. INJ.Piptaz 4.5g BD No change
18. INJ.CP 20Lakh Q6H IV No change
13. T.Atorva 10mg 0-0-1 No proper indication
19. T.Sevalmer 400mg 1-1-1 Duplication

16. PATIENT COUNSELLING
Diet and life style
 Take proper rest.
 Avoid salty foods such as pickles, fast food
and salted nuts.
 Decrease protein food intake such meat, egg,
cheese and milk.
 Avoid phosphorus rich foods such as chocolate
drinks, ice creams and sea foods.
 Avoid potassium rich foods such as banana,
sweet potato and milk.
 Do mild exercise such as bending legs and
move around to avoid blood clots.

17. Drug counseling
MEDICINE
NAME
TIME ROUT OF
ADMINISTR
ATION
PRECUATION AND
MONITORING
M A E N
T.Amlong   ---  Oral Check blood pressure
T.Atorax --- --- ---  Oral Take only at night
T.Revalmer   ---  Oral Monitor phosphorus
level
INJ.Epotrust --- --- --- --- IV Only thrice in a week
INJ.Calcium
gluconate
 ---  --- IV Monitor Calcium &
Potassium level
INJ.Dextrose  ---  --- Infusion Monitor blood glucose
level
NEB.Asthalin     Inhalation ---
Potassium bind
sachet
  ---  Oral by mix
with water
Monitor potassium
level
INJ.Taxim  ---  --- IV ---
INJ.Valparin
Chrono
 --- --- --- IV ---

18. T.Atorva --- --- ---  Oral Only take at night
T.Dolo --- --- --- --- Oral Take when ever
necessary and
monitor body
temperature
T.Epilex Chrono  --- ---  Oral ---
T.Levacetam --- --- ---  Oral ---
INJ.Piptaz  --- ---  IV ---
INJ.CP  ---  --- IV ---

19. PHARMACIST INTERVENTION
 Check phosphorus level
 Check cholesterol level

20. THANK YOU