That case was one patient condition explain. all infomation here but only personal address not like name ,live,etc.

1. CASE PRESENTATION ON CHRONIC
ALCOHLIC WITH CLD WITH PRE
HYPERTENTION
Department of Pharmacy Practice
ISF College of Pharmacy, Moga 142001,
Punjab, INDIA
Presented By: Tek singh
PharmD (2nd year)
Date:

2. CHRONIC ALCOHOLIC
 The term alcoholic refers to a person who suffers from
alcoholism. Alcoholism is the chronic, severe illness
characterized by four key symptoms including: craving,
loss of control, tolerance and physical dependence.

3.  CHRONIC LIVER DISEASE
 Chronic liver disease in the clinical context is a disease process
of the liver that involves a process of progressive destruction and
regeneration of the liver parenchyma leading to fibrosis and
cirrhosis. "Chronic liver disease" refers to disease of the liver
which lasts over a period of six months.

4.  ETIOLOGY OF CLD:-
Alcohol
Chronic viral hepatitis(B or C)
Immune
Primary sclerosing cholangitis
Autoimmune liver disease
Biliary
• Primary biliary cirrhosis(PBC)
• Cystic fibrosis
Genetic
Haemochromatosis
• Wilson’s disease
α1-antitrypsin deficiency
Cryptogenic (unknown-
15%)
Chronic venous outflow
obstruction
 Any chronic liver disease
Drug(e.g methotrexate)
• Galactosaemia
Glycogen storage disease

5.  PATHOPHYSIOLOGY:-
 After liver injury cytokines
produced by kuffer cell and
hepatocytes which activates stellate
cell and transforms into
myofibroblast like cell, capable of
producing collagen, pro-
inflammatory cytokines and tissue
fibrosis.

7.  SYMPTOMS:-
 Fluid buildup in the belly (ascites)
Vomiting blood, often from bleeding in the blood
vessels in the food pipe (esophagus)
Gallstones
Itching
Yellowing of the skin and eyes (jaundice)
Kidney failure
Muscle loss
Loss of appetite
Easy bruising
Spider-like veins in the skin
Low energy and weakness (fatigue)
Weight loss
Confusion as toxins build up in the blood

8.  PRE-HYPERTENSION

In prehypertension, the systolic (top number)
reading is 120 mmHg-139 mmHg, or the diastolic
(bottom number) reading is 80 mmHg-89 mmHg.
Prehypertension is a warning sign that you may get high
blood pressure in the future. High blood pressure
increases your risk of heart attack, stroke, coronary heart
disease, heart failure, and kidney failure. There's no cure
for high blood pressure, but there is treatment with diet,
lifestyle habits, and medications.

9. SUBJECTIVE
PATIENT DETAILS
NAME: XYZ WEIGHT: 70.90 Kg.
AGE:46Yrs. BLOOD GROUP- O +VE
SEX: MALE WARD: MEDICINE-II
HEIGHT: 5’8ft. D.O.A: 06/02/17

10.  Chief Complain:-
 Patient is presented in OPD case of disturbance of abdominal for
last 4 days.
Peripheral edema for last 3 days.
 And devolve distension of abdominal pain.
 Brief History:-
No H/o chest pain
No H/o HTN/DM/Asthma and allergy
 Chronic Alcoholic with
400ml/day

11. Past History:-No such illness in the past
Past Medication History:-No past medication
history
Social History:- Patient was chronic Alcoholic with
smoker
 Allergy History:-
: NKDA
Family History:-
No such family history is there

12.  Physical examination:-
General:-Sick and consciousness
 Vital examination:- BP-135/88
CNS:-HMF-Normal
CVS
S1,S2-Normal

13. LABORATORY INVESTIGATIONS
Lab. Investigations Observed value Normal value
MCV 72.1 80-95fl 86-98mm^3
MCH 23.0 28-33pgcell
MCHC 31.9 32-36gdl
RDW-CV 18.4 11.5-14.5%
PDW 9.5 0.20-0.36%
PLT 83*10^3/uL 150000-450000mcL
PCT 0.06% 0.05ngmL
P-LCR 4.3% 150-520*10^3cu mm
GRAN# 1.5*10^3/uL 13-18gdl
HCT/PCV/Ht 26.6 Male,42-52%
Female,37-48%
Neutrophils 60 40-60% 3000-7000
Lymphocyte 20 20-40% 1000-4000
Monocyte 0.3% 2-8% <850
Eosinophils 17% 1-4% <450

14. LABORATORY INVESTIGATIONS
Lab. Investigation Observed value Normal value
Basophils 0.0-0.1*10^9/L
HGB/Hb 8.5 M-13-17, F-12-16 g/dL
WBC 2.9 4.5-11*10^3/uL
Blood urea 17 2.5-6.7 mmol/L, 7-20 mg/dL
Serum Creatinine 0.6 M-68-150 μmol/L, 0.7-1.3 mg/dL
W-68-98 μmol/L, 0.6-1.1 mg/dL
T.Bilirubin 2.0 5-17 μmol/L 0.3-1 mg/dL
D.Bilirubin 0.7 <7 μmol/L <0.4 mg/dL
AST 43 <20 IU/L
ALP 87 32-92 IU/L
ALT 20 <40 IU/L
Na+ 130 135-145 mEq/L
K+ 3.0 3.5-5 mEc/L
Cl- 98-106 mEq/L

15. Assessment
PROVISIONAL DIAGNOSIS
The patient has been diagnosed with Chronic
Alcoholic with CLD with pre-Hypertension with
ascites…

16. Plan
Treatment and Progress
Drugs G.Name Route Dose Frequency D1 D2 D3 D4 D5
Inj.Lasix Furosemide IV 20mg/
2ml
BD √ √ _ _ _
Syp.
Looz
Lactulose Oral 30ml HS √ √ √ √ √
Cap. Rabirose
+ D
Rabeprazole Oral 20mg/
30mg
OD √ √ √ √ √
Tab.Rifabac Rifaximin Oral 550mg BD √ √ √ √ √
Tab.Dytor
plus
Torsemide
Oral
20mg BD _ _ √ √ √
Tab.Ciplar Propranolol Oral 20mg HS √ √ √ √ √
Inj.zanocin IV 200mg BD _ _ _ _ _
D6
_
√
√
√
√
√
√

17. PHARMACISTS INTERVENTIONS
 Furosemide:-Concurrent use of FUROSEMIDE and FOOD may
result in decreased furosemide exposure and efficacy.
 Propranolol (20mg) + Rabeprazole (30mg):-Concurrent
use of PROPRANOLOL and SELECTED CYP2C19 INHIBITORS may
result in increased propranolol exposure.

18. PATIENT COUNCELING
 Weight gain
 Stop smoking ,alcohol and reduce intake of dietary saturated fat and
cholesterol for overall liver health
 Reduce sodium intake as it serves as therapy for pre-hypertension
 Increase intake of high fiber fruits because decrease the liver
function for metabolism
 Minimum 30 minute aerobic exercise (Not difficult) with yoga
daily for most of day