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case on Tuberculosis (shahnawaz)
- 1. CASE STUDY ON TUBERCULOSIS PresentedBy- Shahnawaz Ahmad Teli M.Pharm 2st Sem. (Clinical Pharmacy)
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- 3. Patient ID:731560/16 Patient name: XYZ Age: 18 years Gender: Female Weight: 40 kg Date of admission: 29/09/16 Date of discharge: 06/10/16 PATIENT DETAILS- SUBJECTIVE
- 4. REASON FOR ADMISSION-SUBJECTIVE (CONT..) Chronic Headache from 15 days Vomiting fever •Past Medical History- Not significant •Past Medication History - Nil •Family history: Nil •Social history: non-alcoholic, non-smoker
- 5. General condition-- sick CNS -- Conscious, well oriented CVS -- s1 & s2 sounds heard Chest -- normal breathing P/A -- soft , non tender , non distended, no organomegaly PHYSICAL EXAMINATION:-
- 6. LABORATORY DATA- Investigation 30/09/1602/10/16 Normal Values Creatinine (L) 0.7 0.8- 1.5 mg/dl Hb (L) 12.1 13-17 gm/dl RBC (L) 3.38 4.5 – 5.5 millions/cu.mm PCV (L) 36.5 40-50 % MCV (L) 78 83-99 fl/red cell MCH (H) 35.8 27-33 pg/cell ESR (H) 25 Less than 15mm/hr. TLC (L) 4240 4000-11000 /cu.mm
- 7. Investigation 30/09/16 02/10/16Normal Values Sodium (L) 130 137-145 mmol/l Neutrophil (N) 83 44-68 % Lymphocyte (L) 15 25-45 % Eosinophil (L) 0 1-6% LABORATORY DATA-(CONTI..)
- 8. DAY TO DAYASSESSMENT Day 1- c/o- o chronic Headache on and off from 15 days. o vomiting Medication- Tab. Calpol (paracetamol) 650 mg SOS Vitals- NORMAL Advice: Chest x-ray
- 9. Day 2- Pt.stable Montox reactive Vitals normal Rx- Inj. Mannitol 200ml over 1 hr. Tab.Rantac (Ranitidine) 50mg BD Adv.- CT scan brain o Day 3- c/o- involuntary shaking of right hand fingers Vitals: Normal Rx- Inj. Dexamethasone 6mg iv 6 hrly. Tab.rifampicin+isoniazid (450+300mg OD) Tab.Ethambutol 800mg OD Tab.Pyrazinamide 750mg BD Tab.shelcal OD
- 10. Day 4- C/O–same stop Mannitol Rest CST o Day 5- Advice: ivF DNS 500ml+5ml kcl 12 hrly Rest Rx- Rest CST o Day 6- Pain in abdomen Advice: ivF Stop Rantac 100mg o Day 7- patient better Rest o Day 8- No fresh complaints patient stable patient discharged
- 11. OTHER INVESTIGATIONS CTscan: fronto temporal edema. MRI: left frontoparieral region with significat perilesional edema and extension of edema in left gangliocapsular region.
- 12. MEDICATION CHART Name, strength,route, frequency Date started Date Class stopped Inj.Mannitol 200ml (1hr) 30/09/16 03/10/16 Osmotic diuretic Tab.Paracetamol 650mg SOS 29/09/16 SOS Analgesic,antipyretic Tab. Ranitidine 50mg BD 30/09/16 05/10/17 H2-blocker Tab.Methylprednisolone 40mg po BD 05/10/16 06/10/17 Corticosteroid Inj. Dexamethasone 6mg iv 6 hrly. 02/10/16 04/10/16 Corticosteroid
- 13. Name, strength, route, frequencyDate started Date Class stopped Tab.Rifampicin + Isoniazid (450+300mg) OD 02/10/16 Antibiotic, Nicotinic acid derivative Tab. Ethambutol (800mg) OD 02/10/16 antimicrobial Tab. Pyrazinamide (750mg) BD 02/10/16 Antibiotic, Nicotinic acid derivative Tab. Ca.carbonate + vit.D3 OD 02/10/16 Nutrition MEDICATION CHART (CONT…)
- 14. CLINICAL JUSTIFICATION Mannitolwas given for edema in the temporal region. Corticosteroids help to reduce inflammation of the surface of the brain and associated blood vessels, and are thought to decrease pressure inside the brain and thus reduces the risk of death. Pyridoxine should be given with Isoniazid. Isoniazid interferes competitively with pyridoxine metabolism by inhibiting the formation of the active form of the vitamin, and hence often results in peripheral neuropathy.
- 15. DISCHARGE SUMMARY- Tab.Rifampicin+ Isoniazid (450+300mg) OD for 4 months Tab. Ethambutol (800mg) OD for 2 months Tab. Pyrazinamide (750mg) BD for 2 months Tab. Ca.carbonate + vit.D3 OD
- 16. PATIENT COUNSELLING Adheranceto the drugs. Non-adherance to tuberculosis treatment can lead to prolonged periods of infectiousness, relapse, emergence of drug-resistance and increased mortality and morbidity.
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