SlideShare a Scribd company logo
1 of 19
BY,
SRIRAM THIRUNAVUKKARASU,
PHARM.D IIIRD YEAR,
380020514525,
PGP COLLEGE OF PHARMACEUTICAL SCIENCE AND
RESEARCH INSTITUTE,
NAMAKKAL.
CASE STUDY ON
CHRONIC KIDNEY DISEASE
CASE SUMMARY
• A 73 years old female patient was admitted in hospital on 11/07/2023 with chief complaint of
sudden onset of fever with chills and rigors associated with decreased urine output. Now she is
admitted for further evaluation and treatment.
• The patient has past medical history of Diabetes mellitus, Systemic hypertension and Chronic
kidney injury.
• The patient has past medication history of Inj.Human mixtard, T. Taurine + Acetyl cysteine, T.
Rosuvastatin, T. Torsemide and T. Alprazolam.
• The patient was diagnosed to be Cystitis, Diabetic nephropathy and Acute kidney disease on
Chronic kidney disease.
• She has no social history .
• She has no known food or drug allergies.
• Inj. Meropenem, Inj. Paracetamol, Inj. Pantoprazole, Inj. Ondansetron, Inj. Human mixtard, T.
Taurine + Acetyl cysteine, T. Rosuvastatin, T. Torsemide, T. Levofloxacin and T. Alprazolam were
the drugs given to the patient during hospitalization.
• She was discharged on 14.7.2023.
CHRONIC KIDNEY DISEASE
DEFINITION
• CKD is a condition in which the kidneys are damaged and cannot filter blood as well as
they should.
• Because of this, excess fluid and waste from blood remain in the body and may cause
other health problems, such as heart disease and stroke.
PATHOPHYSIOLOGY
SOAP ANALYSIS
SUBJECTIVE
• A 73 years old female patient was admitted in hospital on 11/07/2023 with chief
complaint of sudden onset of fever with chills and rigors associated with decreased
urine output. Now she is admitted for further evaluation and treatment.
• The patient has past medical history of Diabetes mellitus, Systemic hypertension
and Chronic kidney disease.
• The patient has past medication history of Inj.Human mixtard, T. Taurine + Acetyl
cysteine, T. Rosuvastatin, T. Torasemide and T. Alprazolam.
• The patient was diagnosed to be Cystitis, Diabetic nephropathy and Acute kidney
disease on Chronic kidney disease.
• She has no social history .
• She has no known food or drug allergies.
• The patient was conscious, oriented and febrile.
• No head injury
• Eye movement normal
• CVS - S1S2 Normal
• RS - B/L AE(+)
• CNS – NFND.
• GIT-P/A - Soft.
• The patient have peripheral edema and distended abdomen.
OBJECTIVE
On Physical Examination,
S.
NO
PARAMETERS DAY 1 DAY 2 DAY 3 DAY 4
NORMAL
RANGE
1. TEMPERATURE 100 99 98 97.5 97.2-98.8 ֯ F
2. BLOOD PRESSURE 100/70 110/50 130/75 120/90
120/80
mmHg
3. PULSE RATE 64 82 80 90
60-100
Beats/min
4.
RESPIRATORY
RATE
18 16 20 18
12-16
breaths/ min
5. SPO2 94 98 96 96 95-100%
VITAL SIGNS:
LABORATORY TEST:
LAB INVESTIGATION 11/7/23 NORMAL VALUES
FULL BLOOD COUNT
Hb 10.4 12-15 g/dL
RBC 4.01 4-5.65 million cells/cu.mm
WBC 11930 4000-11300 cells/cu.mm
PCV 31.06 40-52%
Platelet 149000 150000 - 450000 cells/µl
LIPID PROFILE
T. Cholesterol 175.9 0-200 mg/dL
TG 92.8 40-200 mg/dL
HDL 47 >50 mg/dL
LDL 110.34 <100 mg/dL
VLDL 18.56 3-20 mg/dL
PARAMETERS 11/7 12/7 13/7 14/7
NORMAL
RANGE
UREA 68.9 57 41.1 40 10-50mg/dL
SERUM
CREATININE
2.39 1.75 1.54 1.03 0.7-1.2mg/dL
SODIUM 132.6 131.0 132.0 133.6 133-145mEq/L
POTASSIUM 4.9 5.1 4.1 3.4 3.3-5.1mEq/L
RENAL PROFILE
PARAMETER 11/7 12/7 13/7 14/7
NORMAL
RANGE
FBS 82 81 86 103 60-100mg/dL
OTHERS
URINE ANALYSIS VALUES NORMAL RANGE
Pus cells 80-100 0-5 cells/hpf
RBC 30-40 0 - 3 cells/hpf
Epithelial cells 2-3 15 - 20 cells/hpf
Specific Test
USG Abdomen and Pelvis Impressions
• Cystitis
• Mild spleenomegaly
PLAN
Goals Of Therapy,
 To treat the acute kidney injury via supportive care and antibiotic therapy for
infection.
 To screen for increase Hemoglobin content naturally or to preceed with blood
transfusion.
 To retain the normal urine output.
 To treat fever.
 To treat edema.
THERAPHY :-
DRUG DOSE ROA FREQUENCY 11/7 12/7 13/7 14/7
Inj. Meropenem 1 g IV TDS    
Inj.Paracetamol 1 g IV OD    
Inj. Pantoprazole 40 mg IV OD    
Inj. Human mixtard 10U-0-6U SC BD    
Inj. Ondansetron 8 mg IV TDS    
T. Acetylcysteine +
Taurine
500 + 150
mg
Oral OD   
T. Rosuvastatin 10 mg Oral OD    
T. Torsemide 10 mg Oral OD    
T. Levofloxacin 500 mg oral OD   
T. Alprazolam 0.5 mg Oral OD    
DRUG-DRUG INTERACTION
DRUG – 1 DRUG – 2 INTERACTION
Levofloxacin Alprazolam
levofloxacin increases levels of alprazolam by
decreasing metabolism.
Levofloxacin Ondansetron
levofloxacin and ondansetron both increase QTc
interval. Avoid or Use Alternate Drug
levofloxacin Human mixtard
levofloxacin increases effects of insulin regular
human by pharmacodynamic synergism. Use
Caution/Monitor. Quinolone antibiotic
administration may result in hyper- or
hypoglycemia.
DISCHARGE MEDICATION
S.NO DRUG DOSE FREQUENCY
1. Human Mixtard 30/70 BD(10U-0-6U)
2. T. Faropenem 200 mg BD(1-0-1)
3. T. Acetylcysteine+ Taurine 650mg OD(1-0-0)
4. T. Rosuvastatin 10 mg OD(0-0-1)
5. T. Torsemide 10 mg OD(1-0-0)
6. Cap.Esomeprazole 40 mg BD(1-0-1)
7. T. Alprazolam 0.5 mg OD(0-0-1)
DRUG BASED COUNSELLING
Take the medication properly in a correct dose and time properly.
Do inform the physician if you have any adverse effect.
T. Esomeprazole should be taken before meal time.
T. Alprazolam should be taken at the night time.
DISEASE BASED COUNSELLING
 CKD is a condition in which the kidneys are damaged and cannot filter blood as well
as they should.
 AKD is a condition of sudden deline function of kidney on your chronic kidey disease.
 The fluid accumulation in stomach area and legs are the symptoms of this disease.
PATIENT COUNSELLING
DIET BASED COUNSELLING
Avoid junk foods and high fatty.
Follow a no carbohydrate diabetic diet.
Decrease your salt intake.
Follow a low hydrated diet with good protein and fibre intake.
Avoid Ice creams and other outside foods.
Its better to have steamed vegetable without cooking it or spicing up with spices and oil.
LIFESTYLE BASED COUNSELLING
 Have enough rest.
 Sleep well at night and avoid overthinking.
 Be in a stress free environment.
 Don't put your legs fall on gravity for longer time.
 Sleep on one side rather than sleeping straight.
PHARMACIST INTERVENTION
 From the medication chart analysis, it was found that a serious interaction persist that
needs to be taken measure that levofloxacin and ondansetron both increase QTc interval
as she is proned to have some cardiac issues on her past medical history.
 The edematous symptoms persists yet. So she can be given with either Spironolactone
and Furosemide or Spironolactone and Toresemide which is the most widely used
combination for edema.
THANK YOU

More Related Content

Similar to CASE STUDY ON CHRONIC KIDNEY DISEASE.pptx

Case study on peptic ulcer disease
Case study on peptic ulcer diseaseCase study on peptic ulcer disease
Case study on peptic ulcer diseasekrishna mathiyarasan
 
Nephrotic syndrome
Nephrotic syndromeNephrotic syndrome
Nephrotic syndromeKAVIYA AP
 
4. Case Presentation dengue with thrombocytopenia
4. Case Presentation dengue with thrombocytopenia4. Case Presentation dengue with thrombocytopenia
4. Case Presentation dengue with thrombocytopeniaNisargaS12
 
CASE PRESENTATION ON MILD HEPATOMEGALY 54454.pptx
CASE PRESENTATION ON MILD HEPATOMEGALY 54454.pptxCASE PRESENTATION ON MILD HEPATOMEGALY 54454.pptx
CASE PRESENTATION ON MILD HEPATOMEGALY 54454.pptxkrishna keerthi
 
Case Study Presentation-Rachael Joseph
Case Study Presentation-Rachael JosephCase Study Presentation-Rachael Joseph
Case Study Presentation-Rachael JosephRachael Joseph
 
Angina, cardiovascular disease, Heart, Health
Angina, cardiovascular disease, Heart, HealthAngina, cardiovascular disease, Heart, Health
Angina, cardiovascular disease, Heart, HealthAmar Prasad
 
case study on urinary tract infection.pptx
case study on urinary tract infection.pptxcase study on urinary tract infection.pptx
case study on urinary tract infection.pptxdrsriram2001
 
case study on urinary tract infection.pptx
case study on urinary tract infection.pptxcase study on urinary tract infection.pptx
case study on urinary tract infection.pptxdrsriram2001
 
Seminar nada pdf.pdf
Seminar nada pdf.pdfSeminar nada pdf.pdf
Seminar nada pdf.pdfNadaSAlotibi
 
DIABETES CARDIOMYOPATHY
DIABETES CARDIOMYOPATHYDIABETES CARDIOMYOPATHY
DIABETES CARDIOMYOPATHYKAVIYA AP
 
a case study on gastroenteritis
 a case study on gastroenteritis  a case study on gastroenteritis
a case study on gastroenteritis martinshaji
 
Case Presentation on Diabetes Mellitus complications
Case Presentation on Diabetes Mellitus complicationsCase Presentation on Diabetes Mellitus complications
Case Presentation on Diabetes Mellitus complicationsShivankAgrawal5
 
Approaches to Univestigated Dyspepsia
Approaches to Univestigated DyspepsiaApproaches to Univestigated Dyspepsia
Approaches to Univestigated DyspepsiaSoroy Lardo
 
A case study on Pangastritis with pancreatitis
A case study on Pangastritis with pancreatitis A case study on Pangastritis with pancreatitis
A case study on Pangastritis with pancreatitis martinshaji
 
hypoglycemia presentation oncall duty.pptx
hypoglycemia presentation oncall duty.pptxhypoglycemia presentation oncall duty.pptx
hypoglycemia presentation oncall duty.pptxHamadAlablani2
 
8. a case study on typhoid fever
8. a case study on typhoid fever8. a case study on typhoid fever
8. a case study on typhoid feverDr. Ajita Sadhukhan
 
SAI DEEPAK CASE STUDY ON CHRONIC KIDNEY DISEASE
SAI DEEPAK CASE STUDY ON CHRONIC KIDNEY DISEASESAI DEEPAK CASE STUDY ON CHRONIC KIDNEY DISEASE
SAI DEEPAK CASE STUDY ON CHRONIC KIDNEY DISEASESaiDeepakS1
 

Similar to CASE STUDY ON CHRONIC KIDNEY DISEASE.pptx (20)

Seizure
Seizure Seizure
Seizure
 
Case study on peptic ulcer disease
Case study on peptic ulcer diseaseCase study on peptic ulcer disease
Case study on peptic ulcer disease
 
Nephrotic syndrome
Nephrotic syndromeNephrotic syndrome
Nephrotic syndrome
 
Nephrotic syndrome
Nephrotic  syndromeNephrotic  syndrome
Nephrotic syndrome
 
4. Case Presentation dengue with thrombocytopenia
4. Case Presentation dengue with thrombocytopenia4. Case Presentation dengue with thrombocytopenia
4. Case Presentation dengue with thrombocytopenia
 
CASE PRESENTATION ON MILD HEPATOMEGALY 54454.pptx
CASE PRESENTATION ON MILD HEPATOMEGALY 54454.pptxCASE PRESENTATION ON MILD HEPATOMEGALY 54454.pptx
CASE PRESENTATION ON MILD HEPATOMEGALY 54454.pptx
 
Case Study Presentation-Rachael Joseph
Case Study Presentation-Rachael JosephCase Study Presentation-Rachael Joseph
Case Study Presentation-Rachael Joseph
 
Angina, cardiovascular disease, Heart, Health
Angina, cardiovascular disease, Heart, HealthAngina, cardiovascular disease, Heart, Health
Angina, cardiovascular disease, Heart, Health
 
case study on urinary tract infection.pptx
case study on urinary tract infection.pptxcase study on urinary tract infection.pptx
case study on urinary tract infection.pptx
 
case study on urinary tract infection.pptx
case study on urinary tract infection.pptxcase study on urinary tract infection.pptx
case study on urinary tract infection.pptx
 
Seminar nada pdf.pdf
Seminar nada pdf.pdfSeminar nada pdf.pdf
Seminar nada pdf.pdf
 
DIABETES CARDIOMYOPATHY
DIABETES CARDIOMYOPATHYDIABETES CARDIOMYOPATHY
DIABETES CARDIOMYOPATHY
 
a case study on gastroenteritis
 a case study on gastroenteritis  a case study on gastroenteritis
a case study on gastroenteritis
 
Case Presentation on Diabetes Mellitus complications
Case Presentation on Diabetes Mellitus complicationsCase Presentation on Diabetes Mellitus complications
Case Presentation on Diabetes Mellitus complications
 
sle depression case
sle depression casesle depression case
sle depression case
 
Approaches to Univestigated Dyspepsia
Approaches to Univestigated DyspepsiaApproaches to Univestigated Dyspepsia
Approaches to Univestigated Dyspepsia
 
A case study on Pangastritis with pancreatitis
A case study on Pangastritis with pancreatitis A case study on Pangastritis with pancreatitis
A case study on Pangastritis with pancreatitis
 
hypoglycemia presentation oncall duty.pptx
hypoglycemia presentation oncall duty.pptxhypoglycemia presentation oncall duty.pptx
hypoglycemia presentation oncall duty.pptx
 
8. a case study on typhoid fever
8. a case study on typhoid fever8. a case study on typhoid fever
8. a case study on typhoid fever
 
SAI DEEPAK CASE STUDY ON CHRONIC KIDNEY DISEASE
SAI DEEPAK CASE STUDY ON CHRONIC KIDNEY DISEASESAI DEEPAK CASE STUDY ON CHRONIC KIDNEY DISEASE
SAI DEEPAK CASE STUDY ON CHRONIC KIDNEY DISEASE
 

More from drsriram2001

DIURETIC DRUGS MEDICINAL CHEMISTRY .pptx
DIURETIC DRUGS MEDICINAL CHEMISTRY .pptxDIURETIC DRUGS MEDICINAL CHEMISTRY .pptx
DIURETIC DRUGS MEDICINAL CHEMISTRY .pptxdrsriram2001
 
Pharmacotherapy of Gastroenteritis infection.pptx
Pharmacotherapy of Gastroenteritis infection.pptxPharmacotherapy of Gastroenteritis infection.pptx
Pharmacotherapy of Gastroenteritis infection.pptxdrsriram2001
 
Pharmacotherapy Of Tuberculosis infection.pptx
Pharmacotherapy Of Tuberculosis infection.pptxPharmacotherapy Of Tuberculosis infection.pptx
Pharmacotherapy Of Tuberculosis infection.pptxdrsriram2001
 
HIV AND OPPORTUNISTIC INFECTIONS IN HIV.pptx
HIV AND OPPORTUNISTIC INFECTIONS  IN HIV.pptxHIV AND OPPORTUNISTIC INFECTIONS  IN HIV.pptx
HIV AND OPPORTUNISTIC INFECTIONS IN HIV.pptxdrsriram2001
 
MALARIAL FEVER A CASE PRESENTATION .pptx
MALARIAL FEVER A CASE PRESENTATION .pptxMALARIAL FEVER A CASE PRESENTATION .pptx
MALARIAL FEVER A CASE PRESENTATION .pptxdrsriram2001
 
Etiology, pathophysiology, Pharmacotherapy of AIDS .pptx
Etiology, pathophysiology, Pharmacotherapy of AIDS .pptxEtiology, pathophysiology, Pharmacotherapy of AIDS .pptx
Etiology, pathophysiology, Pharmacotherapy of AIDS .pptxdrsriram2001
 
ANGINA PECTORIS.pptx
ANGINA PECTORIS.pptxANGINA PECTORIS.pptx
ANGINA PECTORIS.pptxdrsriram2001
 
OCULAR DRUG DELIVERY SYSTEM.pptx
OCULAR DRUG DELIVERY SYSTEM.pptxOCULAR DRUG DELIVERY SYSTEM.pptx
OCULAR DRUG DELIVERY SYSTEM.pptxdrsriram2001
 
MANUFACTURING OF PARENTRALS.pptx
MANUFACTURING OF PARENTRALS.pptxMANUFACTURING OF PARENTRALS.pptx
MANUFACTURING OF PARENTRALS.pptxdrsriram2001
 
DIAGNOSTIC AGENTS SRIRAM.pptx
DIAGNOSTIC AGENTS SRIRAM.pptxDIAGNOSTIC AGENTS SRIRAM.pptx
DIAGNOSTIC AGENTS SRIRAM.pptxdrsriram2001
 
OPHTHALMIC PREPARATIONS.pptx
OPHTHALMIC     PREPARATIONS.pptxOPHTHALMIC     PREPARATIONS.pptx
OPHTHALMIC PREPARATIONS.pptxdrsriram2001
 

More from drsriram2001 (11)

DIURETIC DRUGS MEDICINAL CHEMISTRY .pptx
DIURETIC DRUGS MEDICINAL CHEMISTRY .pptxDIURETIC DRUGS MEDICINAL CHEMISTRY .pptx
DIURETIC DRUGS MEDICINAL CHEMISTRY .pptx
 
Pharmacotherapy of Gastroenteritis infection.pptx
Pharmacotherapy of Gastroenteritis infection.pptxPharmacotherapy of Gastroenteritis infection.pptx
Pharmacotherapy of Gastroenteritis infection.pptx
 
Pharmacotherapy Of Tuberculosis infection.pptx
Pharmacotherapy Of Tuberculosis infection.pptxPharmacotherapy Of Tuberculosis infection.pptx
Pharmacotherapy Of Tuberculosis infection.pptx
 
HIV AND OPPORTUNISTIC INFECTIONS IN HIV.pptx
HIV AND OPPORTUNISTIC INFECTIONS  IN HIV.pptxHIV AND OPPORTUNISTIC INFECTIONS  IN HIV.pptx
HIV AND OPPORTUNISTIC INFECTIONS IN HIV.pptx
 
MALARIAL FEVER A CASE PRESENTATION .pptx
MALARIAL FEVER A CASE PRESENTATION .pptxMALARIAL FEVER A CASE PRESENTATION .pptx
MALARIAL FEVER A CASE PRESENTATION .pptx
 
Etiology, pathophysiology, Pharmacotherapy of AIDS .pptx
Etiology, pathophysiology, Pharmacotherapy of AIDS .pptxEtiology, pathophysiology, Pharmacotherapy of AIDS .pptx
Etiology, pathophysiology, Pharmacotherapy of AIDS .pptx
 
ANGINA PECTORIS.pptx
ANGINA PECTORIS.pptxANGINA PECTORIS.pptx
ANGINA PECTORIS.pptx
 
OCULAR DRUG DELIVERY SYSTEM.pptx
OCULAR DRUG DELIVERY SYSTEM.pptxOCULAR DRUG DELIVERY SYSTEM.pptx
OCULAR DRUG DELIVERY SYSTEM.pptx
 
MANUFACTURING OF PARENTRALS.pptx
MANUFACTURING OF PARENTRALS.pptxMANUFACTURING OF PARENTRALS.pptx
MANUFACTURING OF PARENTRALS.pptx
 
DIAGNOSTIC AGENTS SRIRAM.pptx
DIAGNOSTIC AGENTS SRIRAM.pptxDIAGNOSTIC AGENTS SRIRAM.pptx
DIAGNOSTIC AGENTS SRIRAM.pptx
 
OPHTHALMIC PREPARATIONS.pptx
OPHTHALMIC     PREPARATIONS.pptxOPHTHALMIC     PREPARATIONS.pptx
OPHTHALMIC PREPARATIONS.pptx
 

Recently uploaded

Giudeline: Adverse event CTCAE version 5.pdf
Giudeline: Adverse event CTCAE version 5.pdfGiudeline: Adverse event CTCAE version 5.pdf
Giudeline: Adverse event CTCAE version 5.pdfDr. Afreen Nasir
 
Healthcare Market Overview, May 2024: Funding, Financing and M&A, from Oppenh...
Healthcare Market Overview, May 2024: Funding, Financing and M&A, from Oppenh...Healthcare Market Overview, May 2024: Funding, Financing and M&A, from Oppenh...
Healthcare Market Overview, May 2024: Funding, Financing and M&A, from Oppenh...Levi Shapiro
 
Lactation Mraining Management Session-2-Comm-Building-Conf.ppt
Lactation Mraining Management  Session-2-Comm-Building-Conf.pptLactation Mraining Management  Session-2-Comm-Building-Conf.ppt
Lactation Mraining Management Session-2-Comm-Building-Conf.pptMedidas Medical Center INC
 
Case Presentation: Severe microcytic hypochromic iron deficiency anemia with ...
Case Presentation: Severe microcytic hypochromic iron deficiency anemia with ...Case Presentation: Severe microcytic hypochromic iron deficiency anemia with ...
Case Presentation: Severe microcytic hypochromic iron deficiency anemia with ...Dr. Afreen Nasir
 
Catheterization Procedure by Anushri Srivastav.pptx
Catheterization Procedure by Anushri Srivastav.pptxCatheterization Procedure by Anushri Srivastav.pptx
Catheterization Procedure by Anushri Srivastav.pptxAnushriSrivastav
 
An overview of Muir Wood Adolescent and Family Services teen treatment programs.
An overview of Muir Wood Adolescent and Family Services teen treatment programs.An overview of Muir Wood Adolescent and Family Services teen treatment programs.
An overview of Muir Wood Adolescent and Family Services teen treatment programs.pdamico1
 
The Pfizer testimony by Melissa Mac Atee
The Pfizer testimony by Melissa Mac AteeThe Pfizer testimony by Melissa Mac Atee
The Pfizer testimony by Melissa Mac AteePascalGuyot6
 
تقرير منظمة الصحة العالمية الخاص بالغذاء د حاتم البيطار.pdf
تقرير منظمة الصحة العالمية الخاص بالغذاء د حاتم البيطار.pdfتقرير منظمة الصحة العالمية الخاص بالغذاء د حاتم البيطار.pdf
تقرير منظمة الصحة العالمية الخاص بالغذاء د حاتم البيطار.pdfد حاتم البيطار
 
Session-3-Promoting-Breastfeeding-During-Pregnancy.ppt
Session-3-Promoting-Breastfeeding-During-Pregnancy.pptSession-3-Promoting-Breastfeeding-During-Pregnancy.ppt
Session-3-Promoting-Breastfeeding-During-Pregnancy.pptMedidas Medical Center INC
 
PSYCHOLOGICAL ASPECTS OF REHAB. IN PHYSIOTHERAPY..pdf
PSYCHOLOGICAL ASPECTS OF REHAB. IN PHYSIOTHERAPY..pdfPSYCHOLOGICAL ASPECTS OF REHAB. IN PHYSIOTHERAPY..pdf
PSYCHOLOGICAL ASPECTS OF REHAB. IN PHYSIOTHERAPY..pdfkeerti Gour (PT) Shakya
 
Clinical pharmacy book by parthasarathi.pdf
Clinical pharmacy book by  parthasarathi.pdfClinical pharmacy book by  parthasarathi.pdf
Clinical pharmacy book by parthasarathi.pdfDr. Afreen Nasir
 
Navigating Conflict in PE Using Strengths-Based Approaches
Navigating Conflict in PE Using Strengths-Based ApproachesNavigating Conflict in PE Using Strengths-Based Approaches
Navigating Conflict in PE Using Strengths-Based ApproachesCHICommunications
 
Presentation on Cleft Lip and Cleft Palate
Presentation on Cleft Lip and Cleft PalatePresentation on Cleft Lip and Cleft Palate
Presentation on Cleft Lip and Cleft PalateRahulRoyChowdhury13
 
Leadership Style - Code and Rapid Response Workshop
Leadership Style - Code and Rapid Response WorkshopLeadership Style - Code and Rapid Response Workshop
Leadership Style - Code and Rapid Response WorkshopBrian Locke
 
Personnel and Equipment - Code and Rapid Response Workshop
Personnel and Equipment - Code and Rapid Response WorkshopPersonnel and Equipment - Code and Rapid Response Workshop
Personnel and Equipment - Code and Rapid Response WorkshopBrian Locke
 
An overview of Muir Wood Adolescent and Family Services teen treatment progra...
An overview of Muir Wood Adolescent and Family Services teen treatment progra...An overview of Muir Wood Adolescent and Family Services teen treatment progra...
An overview of Muir Wood Adolescent and Family Services teen treatment progra...pdamico1
 
Mike Lowe’s cancer fight lowe strong shirt
Mike Lowe’s cancer fight lowe strong shirtMike Lowe’s cancer fight lowe strong shirt
Mike Lowe’s cancer fight lowe strong shirtrahman018755
 
Case Presentation: CRYPTOCOCCAL MENINGITIS & ORAL CANDIDIASIS –Opportunistic ...
Case Presentation: CRYPTOCOCCAL MENINGITIS & ORAL CANDIDIASIS –Opportunistic ...Case Presentation: CRYPTOCOCCAL MENINGITIS & ORAL CANDIDIASIS –Opportunistic ...
Case Presentation: CRYPTOCOCCAL MENINGITIS & ORAL CANDIDIASIS –Opportunistic ...Dr. Afreen Nasir
 
Session-16-HIV-and-Replacement-Feeding-revised-2012.ppt
Session-16-HIV-and-Replacement-Feeding-revised-2012.pptSession-16-HIV-and-Replacement-Feeding-revised-2012.ppt
Session-16-HIV-and-Replacement-Feeding-revised-2012.pptMedidas Medical Center INC
 
The Best Foot and Ankle Center of Arizona
The Best Foot and Ankle Center of ArizonaThe Best Foot and Ankle Center of Arizona
The Best Foot and Ankle Center of Arizonajackjohn60
 

Recently uploaded (20)

Giudeline: Adverse event CTCAE version 5.pdf
Giudeline: Adverse event CTCAE version 5.pdfGiudeline: Adverse event CTCAE version 5.pdf
Giudeline: Adverse event CTCAE version 5.pdf
 
Healthcare Market Overview, May 2024: Funding, Financing and M&A, from Oppenh...
Healthcare Market Overview, May 2024: Funding, Financing and M&A, from Oppenh...Healthcare Market Overview, May 2024: Funding, Financing and M&A, from Oppenh...
Healthcare Market Overview, May 2024: Funding, Financing and M&A, from Oppenh...
 
Lactation Mraining Management Session-2-Comm-Building-Conf.ppt
Lactation Mraining Management  Session-2-Comm-Building-Conf.pptLactation Mraining Management  Session-2-Comm-Building-Conf.ppt
Lactation Mraining Management Session-2-Comm-Building-Conf.ppt
 
Case Presentation: Severe microcytic hypochromic iron deficiency anemia with ...
Case Presentation: Severe microcytic hypochromic iron deficiency anemia with ...Case Presentation: Severe microcytic hypochromic iron deficiency anemia with ...
Case Presentation: Severe microcytic hypochromic iron deficiency anemia with ...
 
Catheterization Procedure by Anushri Srivastav.pptx
Catheterization Procedure by Anushri Srivastav.pptxCatheterization Procedure by Anushri Srivastav.pptx
Catheterization Procedure by Anushri Srivastav.pptx
 
An overview of Muir Wood Adolescent and Family Services teen treatment programs.
An overview of Muir Wood Adolescent and Family Services teen treatment programs.An overview of Muir Wood Adolescent and Family Services teen treatment programs.
An overview of Muir Wood Adolescent and Family Services teen treatment programs.
 
The Pfizer testimony by Melissa Mac Atee
The Pfizer testimony by Melissa Mac AteeThe Pfizer testimony by Melissa Mac Atee
The Pfizer testimony by Melissa Mac Atee
 
تقرير منظمة الصحة العالمية الخاص بالغذاء د حاتم البيطار.pdf
تقرير منظمة الصحة العالمية الخاص بالغذاء د حاتم البيطار.pdfتقرير منظمة الصحة العالمية الخاص بالغذاء د حاتم البيطار.pdf
تقرير منظمة الصحة العالمية الخاص بالغذاء د حاتم البيطار.pdf
 
Session-3-Promoting-Breastfeeding-During-Pregnancy.ppt
Session-3-Promoting-Breastfeeding-During-Pregnancy.pptSession-3-Promoting-Breastfeeding-During-Pregnancy.ppt
Session-3-Promoting-Breastfeeding-During-Pregnancy.ppt
 
PSYCHOLOGICAL ASPECTS OF REHAB. IN PHYSIOTHERAPY..pdf
PSYCHOLOGICAL ASPECTS OF REHAB. IN PHYSIOTHERAPY..pdfPSYCHOLOGICAL ASPECTS OF REHAB. IN PHYSIOTHERAPY..pdf
PSYCHOLOGICAL ASPECTS OF REHAB. IN PHYSIOTHERAPY..pdf
 
Clinical pharmacy book by parthasarathi.pdf
Clinical pharmacy book by  parthasarathi.pdfClinical pharmacy book by  parthasarathi.pdf
Clinical pharmacy book by parthasarathi.pdf
 
Navigating Conflict in PE Using Strengths-Based Approaches
Navigating Conflict in PE Using Strengths-Based ApproachesNavigating Conflict in PE Using Strengths-Based Approaches
Navigating Conflict in PE Using Strengths-Based Approaches
 
Presentation on Cleft Lip and Cleft Palate
Presentation on Cleft Lip and Cleft PalatePresentation on Cleft Lip and Cleft Palate
Presentation on Cleft Lip and Cleft Palate
 
Leadership Style - Code and Rapid Response Workshop
Leadership Style - Code and Rapid Response WorkshopLeadership Style - Code and Rapid Response Workshop
Leadership Style - Code and Rapid Response Workshop
 
Personnel and Equipment - Code and Rapid Response Workshop
Personnel and Equipment - Code and Rapid Response WorkshopPersonnel and Equipment - Code and Rapid Response Workshop
Personnel and Equipment - Code and Rapid Response Workshop
 
An overview of Muir Wood Adolescent and Family Services teen treatment progra...
An overview of Muir Wood Adolescent and Family Services teen treatment progra...An overview of Muir Wood Adolescent and Family Services teen treatment progra...
An overview of Muir Wood Adolescent and Family Services teen treatment progra...
 
Mike Lowe’s cancer fight lowe strong shirt
Mike Lowe’s cancer fight lowe strong shirtMike Lowe’s cancer fight lowe strong shirt
Mike Lowe’s cancer fight lowe strong shirt
 
Case Presentation: CRYPTOCOCCAL MENINGITIS & ORAL CANDIDIASIS –Opportunistic ...
Case Presentation: CRYPTOCOCCAL MENINGITIS & ORAL CANDIDIASIS –Opportunistic ...Case Presentation: CRYPTOCOCCAL MENINGITIS & ORAL CANDIDIASIS –Opportunistic ...
Case Presentation: CRYPTOCOCCAL MENINGITIS & ORAL CANDIDIASIS –Opportunistic ...
 
Session-16-HIV-and-Replacement-Feeding-revised-2012.ppt
Session-16-HIV-and-Replacement-Feeding-revised-2012.pptSession-16-HIV-and-Replacement-Feeding-revised-2012.ppt
Session-16-HIV-and-Replacement-Feeding-revised-2012.ppt
 
The Best Foot and Ankle Center of Arizona
The Best Foot and Ankle Center of ArizonaThe Best Foot and Ankle Center of Arizona
The Best Foot and Ankle Center of Arizona
 

CASE STUDY ON CHRONIC KIDNEY DISEASE.pptx

  • 1. BY, SRIRAM THIRUNAVUKKARASU, PHARM.D IIIRD YEAR, 380020514525, PGP COLLEGE OF PHARMACEUTICAL SCIENCE AND RESEARCH INSTITUTE, NAMAKKAL. CASE STUDY ON CHRONIC KIDNEY DISEASE
  • 2. CASE SUMMARY • A 73 years old female patient was admitted in hospital on 11/07/2023 with chief complaint of sudden onset of fever with chills and rigors associated with decreased urine output. Now she is admitted for further evaluation and treatment. • The patient has past medical history of Diabetes mellitus, Systemic hypertension and Chronic kidney injury. • The patient has past medication history of Inj.Human mixtard, T. Taurine + Acetyl cysteine, T. Rosuvastatin, T. Torsemide and T. Alprazolam. • The patient was diagnosed to be Cystitis, Diabetic nephropathy and Acute kidney disease on Chronic kidney disease. • She has no social history . • She has no known food or drug allergies. • Inj. Meropenem, Inj. Paracetamol, Inj. Pantoprazole, Inj. Ondansetron, Inj. Human mixtard, T. Taurine + Acetyl cysteine, T. Rosuvastatin, T. Torsemide, T. Levofloxacin and T. Alprazolam were the drugs given to the patient during hospitalization. • She was discharged on 14.7.2023.
  • 3. CHRONIC KIDNEY DISEASE DEFINITION • CKD is a condition in which the kidneys are damaged and cannot filter blood as well as they should. • Because of this, excess fluid and waste from blood remain in the body and may cause other health problems, such as heart disease and stroke.
  • 6. SUBJECTIVE • A 73 years old female patient was admitted in hospital on 11/07/2023 with chief complaint of sudden onset of fever with chills and rigors associated with decreased urine output. Now she is admitted for further evaluation and treatment. • The patient has past medical history of Diabetes mellitus, Systemic hypertension and Chronic kidney disease. • The patient has past medication history of Inj.Human mixtard, T. Taurine + Acetyl cysteine, T. Rosuvastatin, T. Torasemide and T. Alprazolam. • The patient was diagnosed to be Cystitis, Diabetic nephropathy and Acute kidney disease on Chronic kidney disease. • She has no social history . • She has no known food or drug allergies.
  • 7. • The patient was conscious, oriented and febrile. • No head injury • Eye movement normal • CVS - S1S2 Normal • RS - B/L AE(+) • CNS – NFND. • GIT-P/A - Soft. • The patient have peripheral edema and distended abdomen. OBJECTIVE On Physical Examination,
  • 8. S. NO PARAMETERS DAY 1 DAY 2 DAY 3 DAY 4 NORMAL RANGE 1. TEMPERATURE 100 99 98 97.5 97.2-98.8 ֯ F 2. BLOOD PRESSURE 100/70 110/50 130/75 120/90 120/80 mmHg 3. PULSE RATE 64 82 80 90 60-100 Beats/min 4. RESPIRATORY RATE 18 16 20 18 12-16 breaths/ min 5. SPO2 94 98 96 96 95-100% VITAL SIGNS:
  • 9. LABORATORY TEST: LAB INVESTIGATION 11/7/23 NORMAL VALUES FULL BLOOD COUNT Hb 10.4 12-15 g/dL RBC 4.01 4-5.65 million cells/cu.mm WBC 11930 4000-11300 cells/cu.mm PCV 31.06 40-52% Platelet 149000 150000 - 450000 cells/µl LIPID PROFILE T. Cholesterol 175.9 0-200 mg/dL TG 92.8 40-200 mg/dL HDL 47 >50 mg/dL LDL 110.34 <100 mg/dL VLDL 18.56 3-20 mg/dL
  • 10. PARAMETERS 11/7 12/7 13/7 14/7 NORMAL RANGE UREA 68.9 57 41.1 40 10-50mg/dL SERUM CREATININE 2.39 1.75 1.54 1.03 0.7-1.2mg/dL SODIUM 132.6 131.0 132.0 133.6 133-145mEq/L POTASSIUM 4.9 5.1 4.1 3.4 3.3-5.1mEq/L RENAL PROFILE PARAMETER 11/7 12/7 13/7 14/7 NORMAL RANGE FBS 82 81 86 103 60-100mg/dL OTHERS
  • 11. URINE ANALYSIS VALUES NORMAL RANGE Pus cells 80-100 0-5 cells/hpf RBC 30-40 0 - 3 cells/hpf Epithelial cells 2-3 15 - 20 cells/hpf Specific Test USG Abdomen and Pelvis Impressions • Cystitis • Mild spleenomegaly
  • 12. PLAN Goals Of Therapy,  To treat the acute kidney injury via supportive care and antibiotic therapy for infection.  To screen for increase Hemoglobin content naturally or to preceed with blood transfusion.  To retain the normal urine output.  To treat fever.  To treat edema.
  • 13. THERAPHY :- DRUG DOSE ROA FREQUENCY 11/7 12/7 13/7 14/7 Inj. Meropenem 1 g IV TDS     Inj.Paracetamol 1 g IV OD     Inj. Pantoprazole 40 mg IV OD     Inj. Human mixtard 10U-0-6U SC BD     Inj. Ondansetron 8 mg IV TDS     T. Acetylcysteine + Taurine 500 + 150 mg Oral OD    T. Rosuvastatin 10 mg Oral OD     T. Torsemide 10 mg Oral OD     T. Levofloxacin 500 mg oral OD    T. Alprazolam 0.5 mg Oral OD    
  • 14. DRUG-DRUG INTERACTION DRUG – 1 DRUG – 2 INTERACTION Levofloxacin Alprazolam levofloxacin increases levels of alprazolam by decreasing metabolism. Levofloxacin Ondansetron levofloxacin and ondansetron both increase QTc interval. Avoid or Use Alternate Drug levofloxacin Human mixtard levofloxacin increases effects of insulin regular human by pharmacodynamic synergism. Use Caution/Monitor. Quinolone antibiotic administration may result in hyper- or hypoglycemia.
  • 15. DISCHARGE MEDICATION S.NO DRUG DOSE FREQUENCY 1. Human Mixtard 30/70 BD(10U-0-6U) 2. T. Faropenem 200 mg BD(1-0-1) 3. T. Acetylcysteine+ Taurine 650mg OD(1-0-0) 4. T. Rosuvastatin 10 mg OD(0-0-1) 5. T. Torsemide 10 mg OD(1-0-0) 6. Cap.Esomeprazole 40 mg BD(1-0-1) 7. T. Alprazolam 0.5 mg OD(0-0-1)
  • 16. DRUG BASED COUNSELLING Take the medication properly in a correct dose and time properly. Do inform the physician if you have any adverse effect. T. Esomeprazole should be taken before meal time. T. Alprazolam should be taken at the night time. DISEASE BASED COUNSELLING  CKD is a condition in which the kidneys are damaged and cannot filter blood as well as they should.  AKD is a condition of sudden deline function of kidney on your chronic kidey disease.  The fluid accumulation in stomach area and legs are the symptoms of this disease. PATIENT COUNSELLING
  • 17. DIET BASED COUNSELLING Avoid junk foods and high fatty. Follow a no carbohydrate diabetic diet. Decrease your salt intake. Follow a low hydrated diet with good protein and fibre intake. Avoid Ice creams and other outside foods. Its better to have steamed vegetable without cooking it or spicing up with spices and oil. LIFESTYLE BASED COUNSELLING  Have enough rest.  Sleep well at night and avoid overthinking.  Be in a stress free environment.  Don't put your legs fall on gravity for longer time.  Sleep on one side rather than sleeping straight.
  • 18. PHARMACIST INTERVENTION  From the medication chart analysis, it was found that a serious interaction persist that needs to be taken measure that levofloxacin and ondansetron both increase QTc interval as she is proned to have some cardiac issues on her past medical history.  The edematous symptoms persists yet. So she can be given with either Spironolactone and Furosemide or Spironolactone and Toresemide which is the most widely used combination for edema.