adominal migraine. Treatment for abdominal migraine is based on NICE guidelines and is found to be appropriate for the patient. Based on the guidelines, treatment should include an triptans or NSAID based on the condition of the patient along with an antiemetic drug if vomiting. Symptomatic treatment should be given along with these drugs. But opioids should not be given for paediatric patient according to NICE guidelines and FDA- label

1. B Y ,
L O G E S H W A R Y . M
P H A R M . D V Y E A R
CASE PRESENTATION

2. A 10 year old female patient was admitted in
hospital on 1/08/2018
Chief complaints:
 c/o abdominal pain for 4 months- intake of food increases pain
 c/o burning micturition
History of present illness:
 H/o nausea, burning micturition, constipation
 H/o white discharge for 10 days
 H/o dysuria(++)
 No H/o hematuria
 H/o fever on 3/08/2018
Past medical history:
 K/C/O recurrent abdominal pain-intermittent colicky pain
 Normal FTN-Delivery, neonatal jaundice

3. Allergies: drug: ranitidine
General examination: Normal
Systemic examination
CVS S1S2 (+)
CNS NAD
RS BAE (+)
P/A Soft,tenderness at left lumbar and left iliac region
Habits
Food Normal
Appetite Normal
Sleep Normal
Bowel irregular rhythm bowel habits

4. EXAMINATION
VITALS 1 2 3 4 5 6 7 8 9 10
TEMP 98.4 98.4 99.1 99.5 99.0 98.9 98.5 98.4 98.4 98.4
RR 20
20
22
22
20
22
22
22
20
22
20
22
23
20
22
24
24
22
20
22
PR 98
84
82
86
86
80
80
88
86
80
84
82
86
87
86
80
82
87
86
80
BP 120/
80
Physical examination:
Patient is conscious and oriented
Vaginal examination:
3/08/2018
White discharge, inflammed urethral orifice, labia majora

5. LAB INVESTIGATIONS
Investigations Normal values Investigated values
COMPLETE BLOOD COUNT
Haemoglobin (g%) 10-14 12.5
WBC(cells/ mm3) 3.8-11.0k 9200
Neutrophils(%) 50-81 49
Lymphocytes(%) 14-44 45
Eosinophils(%) 1-5 6
ESR(min) 0-29 4,10
BLOOD SUGAR
RBS(mg/dl) <125 104
RENAL PROFILE
Blood urea(mg/dl) 6-23 16
Sr.creatinine(mg/dl) 0.5-1.1 0.4
LIVER PROFILE
ALT(U/L) 8-32 19
AST(U/L) 6-18 16

6. OTHER INVESTIGATIONS
 USG abdomen
Observations:
Liver : normal
Gal bladder: normal
Pancreas: normal
Spleen: normal
Kidney®(L): normal
Impression:
Normal study

7. Diagnosis
 Abdominal migraine
 ?UTI( Urinary Tract Infection)

8. TREATMENT CHART
Brand name Generic name Dose R.O.A Freq duration
Syp.Alkasol Disodium h2
citrate
1.4g/
5ml
P/O 10ml
BD
         
Syp.Lactulose Lactul ose 3.3g/
5ml
P/O 10ml
HS
    
T.Domstal domperidone 10mg P/O OD     
T.Dicyclomine dicyclomine 20mg P/O BD     
Inj.Taxim cefotaxime 750mg P/O BD   
T.Para acetaminophen 500mg P/O BD        
T.Metrogyl Metronidazole 200mg P/O TDS     
T.Albendazole albendazole 400mg P/O HS 
T.Ilaprazole ilaprazole 10mg P/O 1/2OD     
Inj.Dicyclomine dicyclomine 10mg/
1ml
IM OD     
T.Tramadol tramadol 50mg P/O OD     
C.Bifilac Lactobacillus P/O BD     
T.Ondansetron ondansetron 4mg P/O BD     
IVF.RL IV     

9.  Medication error: Nil
 Drug interactions:
 ondansetron+ tramadol- have an increased risk of serotonin syndrome
 Adverse effects: Nil
 Patient counselling:
 Recognise and avoid triggers which causes initiation of pain.
 Don’t allow the child to take too much of stress
 Be sure the child is getting enough sleep, regular meals and drinking
plenty of water.
 If the child has frequent vomiting give plenty of fluids to avoid
dehydration
 Strictly adhere to the given treatment chart.

10. DISCHARGE SUMMARY
Drugs Dose Route Frequency Duration
Syp.Alkasol 10ml P/O BD 10 days
T.Para 500mg P/O BD 5days
C.Bifilac P/O BD 5days
T.ondansetron 4mg P/O BD 5days
T.Dicyclomine 20mg P/O BD 5days

11. Course in the hospital
 A 10 year old female patient was admitted in hospital
with chief complaints of severe abdominal pain for
past 4 months.
 All lab investigations were normal including ECG
report.
 Finally the patient was diagnosed with Abdominal
migraine based on gastroenterology opinion.
 Treatment with antispasmodics, anti- emetics,
NSAIDs, probiotics and antibiotics were given. As
the abdominal pain recides with the given treatment
the patient was discharged on 11/08/2018.

12. Post intervention
 Paediatric patient should not be given with opioids
for the treatment of migraine and also it has a risk of
developing serotonin syndrome when concomitantly
given with ondansetron

13. Critical analysis of case study
 Treatment for abdominal migraine is based on NICE
guidelines and is found to be appropriate for the patient.
 Based on the guidelines, treatment should include an
triptans or NSAID based on the condition of the patient
along with an antiemetic drug if vomiting. Symptomatic
treatment should be given along with these drugs.
 But opioids should not be given for paediatric patient
according to NICE guidelines and FDA- label
 Hence prescription with tramadol is found to be
inappropriate

14. THANK YOU