A 2-year-old female child presented with vomiting, seizures, and loose stools for 7 days. She had a history of VP shunt placement and surgery for tethered cord syndrome. Examination and tests revealed sepsis with peritonitis, hydrocephalus, and a spinal cord cyst. She was treated with IV antibiotics, anticonvulsants, and other medications. Some drug interactions were noted. She was discharged on oral antibiotics and other medications, with counseling on diet and seizure precautions.

1. CASE PRESENTATION ONCASE PRESENTATION ON
SEPSIS WITH PERITONITISSEPSIS WITH PERITONITIS
BY
D.HIMAJA
14Z91T0004

2. PATIENT DEMOGRAPHIC DETAILSPATIENT DEMOGRAPHIC DETAILS
Name - Sarayu
Age - 2 years
Gender - female
Weight - 10kgs
Height - 76 cms
Ip number - 18003691
Department -paediatrics
Date of admission – 12 /12/18
Date of discharge - 22/12/18

3. SOAP ANALYSISSOAP ANALYSIS

4. SUBJECTIVE EVIDENCESUBJECTIVE EVIDENCE
c/o-vomiting,seizures, loose stools since
7 days.
Past medical history:-right sided VP
shunt with ependymoma.
Past surgical history:- operted for
tethered cord syndrome. Pateint
developed status epilepticus associated
with fever.

5. On examination:-On examination:-
Child is sleeping , afebrile
Abdomen –soft
CNS tone-normal on painful stimuli
CVS - s₁s₂ heard
Breath sounds-clear
Lungs – bilateral air entry.

6. VITALS:-VITALS:-
Pulse rate-86/min
Respiratory rate-24/min
Spo₂ - 99%
Temperature – 98.7°F
Preliminary diagnosis:- hydrocephalus
with bilateral VP shunt ? Peritonitis.

7. OBJECTIVEOBJECTIVE
EVIDENCEEVIDENCE

8. CT brain- hydrocephalus .
USG- Gall bladder –well distended
urinary bladder-empty with folings bulb.
Uterus-Mild IU free fluid with multiple thin
echogenic septation.
MRI- infected epidermoid cyst-dorsal
dermal sinus extending spinal cord at
s₂₋₃lever. Extensive lepto meningitis

9. ASSESSMENTASSESSMENT
From the subjective and objective
findings the child is diagnosed with
sepsis with peritonitis and spastic
paraparesis.

10. DRUG CHARTDRUG CHART
DRUG NAME GENERIC
NAME
DOSE ROUT
E
FREQU
ENCY
1 2 3 4 5 6 7 8 9 10
Isolyte Iv fluids 700ml IV OD + + + + + - - - - --
Taxim Cefixime 250mg IV BD + + + + + + + + + +
Amikacin Amikacin 25mg IV BD + + + + + + + + + +
Levipil Levitriacet
am
20 mg IV BD + + + + + + + + + +
Encorate Sod.
valproate
20 ml IV BD + + + + + + + + + +
Mannitol Mannitol 20ml IV TID + + + + + + + + + +
Lorazepam Lorzepam 10mg IV BD - - - + + + + + + +
Phenytoin Phenytoin 20 mg IV OD - - - - - - + + + +
Cefotaxim Cefotaxim 1 gm IV BD + + + + + - - + + +

11. DRUG NAME GENERIC
NAME
DOSE ROUT
E
FREQU
ENCY
1 2 3 4 5 6 7 8 9 10
Rantac Ranitidine 150mg IV BD - - + + + + + + + +
Ceftriaxone Ceftriaxone 350mg IV BD + + + + + - - - - -
Zofer Ondansetron 2mg IV BD - + + + + + + + + +
Lorazepam Lorazepam 0.7mg IV SOS - - - + + + + + + +
Paracetamol Paracetamol 4 ml oral SOS + + + + + + + + + +
Metrogyl Metronidazol
e
50 mg IV TID - - - - - + + + + +
Meropenem Meropenem 10mg IV BD + + + + + + + + + +
targocid Teicoplanin 70mg IV OD + + + + + + + + + +

12. PHARMACIST INTERVENTIONPHARMACIST INTERVENTION
Therapeutic duplication found I this
prescription :-
Lorazepam a benzodiazepine derivative
drug has been given to the patient in two
different doses i.e, (1mg and 0.7 mg)

13. DRUG INTERACTIONSDRUG INTERACTIONS
 Three major drug- drug interactions were found
in this prescription.
Valproic acid + meropenem
Meropenem decreases levels of valproic acid
by unknown mechanism. Avoid or Use Alternate
Drug. Risk of seizure. Possible decreased GI
absorption and/or increased renal clearance of
valproic acid

14. Amikacin + mannitol
 Co administration of parenteral or inhaled
aminoglycoside antibiotics or oral neomycin in
combination with loop diuretics may potentiate the risk
of oto- or nephrotoxicity due to additive or synergistic
pharmacologic effects of these drugs and or altered
aminoglycoside serum and tissue levels
Amikacin + Teicoplanin
Amikacin and teicoplanin both increase nephrotoxicity
and/or oto toxicity. Avoid or Use Alternate Drug

15. DISCHARGE MEDICATIONSDISCHARGE MEDICATIONS
Syp. Paracetamol 4ml oral sos - 15 days
Inj.rantac 50 mg iv od - 15 days
Tab metrogyl 50 mg oral od - 15 days
Tab ceftriaxone 350mg oral od - 15 days
Tab ondansetron 2 mg oral od - 15 days
Tab phenytoin 10 mg oral od - 15 days
 Review after 15 days in op department

16. PATIENT COUNSELLINGPATIENT COUNSELLING
 Ketogenic diet consisting of relatively low
carbohydrate and adequate protein with high
fats content is to be recommended under the
supervision of dietician .
 Encourage the child to sleep well and take
medications on time .
 Care during seizures allow the saliva secretions
to drain or vomit and do not stop child
movements or convulsions.
 If seizures lasts longer than 5 min seek
immediate treatment.