case presentation

1. CASE PRESENTATION ON LIVER
FAILURE
CICILIYA VJ
KH.PH.U4BPH13013
8th SEMESTER B.PHARM
AMRITA SCHOOL OF PHARMACY

2. DEMOGRAPHIC DETAILS
 MRD NO : 1775191
 PATIENT NAME : Mr. BIJU B
 AGE :44 Y
 SEX : MALE
 SPECIALITY : GASTROENTEROLOGY
 DATE OF ADMISSION : 03/12/2016
 DATE OF DISCHGARGE : 23/01/2017

3. SUBJECTIVE DATA
 REASON OF ADMISSION : 44 yr old Mr Biju has acute on
chronic liver failure(ACLF) , severe alcoholic hepatitis . He
developed LRTI / Pulmonary edema during the hospital stay
.Treated with antibiotics, nebulization. Later developed ascites .
OGD scopy showed e/o esophageal varices .
 HISTORY: h/o chronic ethanol intake presented with c/o
progressive jaundice since 3 weeks to have worsening jaundice,
renal failure and he came here for further management

4.  PERSONAL HISTORY : normal sleep , and appetite ,
bladder and bowel habits
 FAMILY HISTORTY : nil
 ALLERGIES : nil

5. OBJECTIVE DATA
 VITALS
 PR: 76 beats /min
 BP: 130/70mmHg
 RR: 16 breaths/min

6. LAB INVESTIGATIONS

7. HAEMOGRAM
DATE Hb;g/d
l(12.1-
15.1)
PCV :
% (45)
PlT
:ku/ml(15
0-450)
TC:45-
110)
DC:%(
40-80)
L:%(20-
40)
E :%(1-
6)
13/12 8.41 24.3 63.6 15.5 76 12.9 1.65
14/12 9.3 26.2 66 13.97 78.5 12.6 3.8
15/12 8.6 24.1 59 12.86 77.2 13.3 4.4
16/12 8.5 24.1 60 11.62 77.1 14.1 2.9
17/12 8.31 25 63.8 14.5 74.2 10.6 3.11
18/12/ 8.32 24.9 58.7 14.1 69.8 12.7 5.37
20/12 8.5 25.1 46 10.3 73.9 12.7 3.5
21/12 8.5 24.8 46 10.3 71.4 13.3 4.3
22/12 7.8 23 43 7.26 68.4 20.5 5.5
23/12 8.1 23.8 43 7.2 68.4 20.5 5.5

8. 24/12 7.2 20.5 50 6.52 71.2 18.1 5.2
25/12 8.1 24 34 6.93 68.8 17.6 8.8
26/12 8 23.1 23 7.83 67.8 19.7 5.9
27/12 7.5 22.1 31 9.57 80.2 9.4 5
28/12 7.4 21.4 22 10.4 70.9 13.6 8.3
29/12 8.3 24.2 33 10.9 71.8 14.9 6.8
30/12 8.4 24 44 10.6 66.4 15.4 4.7
31/12 8.6 24.3 56 70.7 70.7 17.5 4.7
1/01 9.1 26.7 51 11.8 67.7 18.9 5.8
2/01 9.3 26.1 140 12.8 72.3 15.5 5.4
3/01 8.9 27 75 11.3 58.6 24 3.8
4/01 8.4 24.4 80 11.71 69.6 19.6 4.1
5/01 8.8 25.3 85 11.8 67.4 20 4.9
6/01 8.6 24.2 80 10 66.9 20 4.1

9. LIVER FUNCTION TEST
DATE T:Bilir
ubin(.
3-1.9)
D:bilir
ubin
SGOT:I
U/L
SGPT:I
U/L(5-
40)
ALP
(44-
114)
T:protein(
gm
/dL)
S:al
b
S:glob(g
/dL)
15/12 - - 130.8 40.3 - - - -
17/12 39.6 24.7 165 51.5 69.5 6.43 4 2.4
20/12 32.3 21.6 165.3 60 71.2 6.5 3.85 2.7
24/12 21.7 8.64 216.1 73.9 62.7 7.01 4.28 2.7
26/12 25.9 16 211.3 90.9 67.6 6.77 3.99 2.8
31/12 31.6 21.8 204.9 103.6 70.4 7.08 3.82 3.3
02/01 29.7 22.4 231.7 107.5 80.9 6.9 3.57 3.3
03/01 26.9 19.3 240.5 100.8 77.6 6.28 3.21 3.1
05/01 28.9 17.3 231.7 98.4 83.7 6.1 2.84 3.3
06/01 31.2 17.7 230.1 97.2 77.2 6.02 2.84 3.2
08/01 29.6 18.2 245.9 91.3 83.2 6.43 2.87 3.6
12/01 36.6 19.4 223.1 77.4 78.8 6.52 3.18 3.3
16/01 30.6 17.7 157.9 47.5 80.4 6.45 3.28 3.2

10. RENAL FUNCTION TEST AND SERUM
ELECTROLYTES
Date: Urea
:mg/dL7-20
CREATININE:
mg/dL.(.7-1.3)
Na+:mEq/l K+: Eq/L
12/12 - - - 3.5
13/12 150.5 4.0 137.1 3.5
14/12 128.8 2.95 137 3.2
15/12 163.5 2.93 138.8 2.7
16/12 154.5 2.87 146.8 2.7
17/12 158.1 2.51 150.2 2.7
18/12 137.3 2.13 138.9 3.4
19/12 109 1.99 140.6 3.6
20/12 122.3 2.51 139.7 3.3
21/12 133.5 2.49 139.4 3.6
22/12 136.2 2.29 142.2 3.3

11. 23/12 112 1.96 145.5 3
24/12 95.8 1.78 145.5 3.7
25/12 74.8 1.62 148.7 2.8
26/12 59.9 1.69 147.2 3.3
27/12 57.8 2.01 144.5 3.4
28/12 73.9 2.43 145.5 3
29/12 70.2 2.3 145 2.7
30/12 71.6 2.31 146 2.7
31/12 74.4 2.24 144.5 2.5
1/1 69.2 2 143.2 2.8
2/1 71.4 2 144 2.6
3/1 75 2.2 139.3 3.4
4/1 62.7 2.2 135.3 3.9
5/1 - - 132.3 2.8
6/1 54.9 2.24 131.8 3.8

12. 7/1 48.9 2.18 129.7 5
8/1 51.1 2.38 126.2 4.9
9/1 48.1 2.27 125.2 4
10/1 40.1 1.81 125.1 3.2
11/1 39.5 1.68 126.8 3.2
12/1 39.9 1.95 126.6 4.3
13/1 42.4 2 129.1 3.4
14/1 39.3 1.9 127.3 3.5
15/1 40.4 2 125.8 3.7
16/1 46.7 2.2 125.6 3.8
17/1 57.3 2.2 125.8 3.8
18/1 52.3 1.88 124.6 3.6

13. ASSESSMENT
DIAGNOSIS:
• Acute on chronic liver failure
• Severe Alcoholic Hepatitis Lower respiratory tract
infection with respiratory failure (S/p Intubation)
• Acute kidney injury (non oliguric)
• Ascites

14.  DISEASE DESCRIPTION :
• LIVER FAILURE :large part of liver become damaged , life
threatening condition. Major cause – hepatitis ; inflammation of the
liver which results in damage to hepatocytes with subsequent cell
death
• Symptoms- nausea, loss of appetite, fatigue
• Liver transplantation is common procedure

15.  GOALS OF THERAPY
• Treat hepatitis by getting vaccination
• Reduce the symptoms
PLAN
PLAN OF DISCHARGE : Review with gastro medicine
OPD after 1 week with CBC/CRP/LFT/INR/ISE/RBS
reports

16. DISCHARGE MEDICATION
MEDICATION FREQUEN
CY
DOSE ROUTE
T.TAXIM O 200mg 1-0-1* 1 week p/o
T.PAN 40mg 1-0-1 ‘’ ‘’
T.UDILIV 300mg 1-0-1 ‘’ ‘’
T.RIFAGUT 400mg 1-0-1 ‘’ ‘’
T.NORFLOX 400mg 1-0-0 ‘’ ‘’
T.NEUROBION FORTE 1gm 1-0-0 ‘’ ‘’
T.FLOVITE 5mg 1-0-0 ‘’ ‘’
T.CILACAR 10mg 1-0-1 ‘’ ‘’
T.HEPTRAL 10mg 1-0-1 ‘’ ‘’
T.EVION 400mg 1-0-0 ‘’ ‘’
INJ.HUMAN ACTRAPID 6-6-6 units s.c
HEPATOPROTEIN POWDER 2tsp TID syp p/o
MUCOLITE 10ml BD/SOS*2 ‘’ ‘’

17.  PATIENT COUNSELLING
o Avoid alcohol when you are taking medication
o Practice proper hygiene
o Eat proper diet from all of the food groups
o Don’t share any personal toiletry items
o Don’t handle any blood or blood products
o salt restricted diet , 3 egg white per day
o diabetic diet, 100 gm vegetable protein per day

18. THANK YOU..........