CASE PRESENTATION

1. DISSEMINATED TUBERCULOSIS
BY- D.BHUVANA
PHARM.D 3rd YEAR

2. DEMOGRAPHIC DETAILS
 AGE: 52 YEARS
 GENDER: FEMALE
 DOA: 6/03/2020
 IP NO: 21795

3.  Patient alleged history of fall of home on 03-03-2020 around
morning and hit by ground.
 H/O loc: Headache, productive cough
 H/O seizures.
 History of the 2 episodes of vomiting's.
CHEIF COMPLAINTS:

4.  Present Medical History: Decompressive carinoanatomy & bleed
evacuated tracheostomy done in outside hospital.
 Past Medical History: K/C/O ESRD ON MHD (maintenance of
hemodialysis) Disseminated TB on ATT, HTN
 Past Medication History: Telmisartan.
 Allergies: no
 Family History: Diabetic Father.

5. ESRD –MHD HTN
Disseminated TB,
ACUTE FTP
PROVISIONAL DIAGNOSIS

6. Rx-
1. Inj. Pan-40 mg IV BD.
2. Inj. Colistin-1mg IV TID.
3. Inj. INH- 300 mg OD.
4. T. Combutol- 500mg Alt day.
5. T. Pyzina-1500 mg Alt day.
6. T. Shelecal -1 tab OD.
7. T. Ivabrad- 2.5 mg OD.
8. Inj. Epofit – 6000IU IV.
9. Inj. Levomac- 500mg BD TID.
10. T. cervifin- 50 mg BD TID.
 PHYSICAL EXAMINATION:
CVS: S1&S2+
RS: BAE
P/A: SOFT
 VITAL SIGNS:
PR: 96/min
B.P: 160/80mmhg
Temp: 98°F
 C/O:
Patient alleged history of fall on
home.
DAY-1

7. Rx-
1. Inj. Pan-40 mg IV BD.
2. Inj. Colistin-1mg IV TID.
3. Inj. INH- 300 mg OD.
4. T. Combutol- 500mg Alt day.
5. T. Pyzina-1500 mg Alt day.
6. T. Shelecal -1 tab OD.
7. T. Ivabrad- 2.5 mg OD.
8. Inj. Epofit – 6000 IV.
9. Inj. Levomac- 500mg BD TID.
10. T. cervifin- 50 mg BD TID.
 PHYSICAL EXAMINATION:
CVS: S1&S2+
RS: BAE+
P/A: SOFT
 VITAL SIGNS:
PR: 96/min
B.P: 110/80mmhg
Temp: 98°F
 C/O: Abdominal pain.
 ADV: Continue as per chart.
DAY-2

8. Rx-
1. Inj. Pan-40 mg IV BD.
2. Inj. INH- 300 mg OD.
3. T. Combutol- 500mg Alt day.
4. T. Pyzina-1500 mg Alt day.
5. T. Shelecal -1 tab OD.
6. T. Ivabrad- 2.5 mg OD.
7. Inj. Epofit – 6000IU IV.
8. Inj. Levomac- 500mg BD TID.
9. T. cervifin- 50 mg BD TID.
 PHYSICAL EXAMINATION:
CVS: S1&S2+
RS: BAE+
P/A: SOFT
 VITAL SIGNS:
PR: 98/min
B.P: 120/70mmhg
Temp: 98°F
 C/O:
Patient respond lost.
 ADV:
Stop Inj. Colistin
DAY-3

9. Rx-
1. Inj. Pan-40 mg IV BD.
2. Inj. INH- 300 mg OD.
3. T. Combutol- 500mg Alt days.
4. T. Pyzina-1500 mg Alt days.
5. T. Shelecal -1 tab OD.
6. T. Ivabrad- 2.5 mg OD.
7. Inj. Epofit – 6000IU IV.
8. T. cervifin- 50 mg BD TID.
 PHYSICAL EXAMINATION:
CVS: S1&S2+
RS: BAE+
P/A: SOFT
 VITAL SIGNS:
PR: 94/min
B.P: 110/60mmhg
Temp: 98°F
 C/O:
Patient response is poor.
 ADV:
Stop Inj. Levomac.
DAY-4

10. DISSEMINATED TUBERCULOSIS
FINAL DIAGNOSIS

11. DISSEMINATED TUBERCULOSIS

12.  Miliary TB is form of disseminated
tuberculosis or extra pulmonary
that is caused by sudden diffusion
of the tuberculi through the blood
stream (hematogenous spread of
TB).
 The foci are possible caseous-
necrotic changes. Focal changes
develop in the interstitial tissues.
 In the disseminated TB foci formed
small (1-2mm) with productive
tissue reaction.
 Small foci look like millet grains.

13.  SUBJECTIVE:
A 52 years female patient was admitted in the general ward with the compliance of
the of alleged fall in home.
 OBJECTIVE:
 The patient present history of the decompressive carinoanatomy & bleed
evacuated tracheostomy done in the outside hospital.
 With Past medical history of ESRD( end stage renal disease) on MHD
(maintenance haemodialysis) and Disseminated Tuberculosis.
 Increased levels of serum Creatinine.
 TST (Tuberculin skin test) – 9mm (positive).
SOAP FORMAT

14. ASSESSMENT:
 Patient TST value is 9mm that indicates that the patient was infected with
the mycobacterium tuberculi and would immediately start the treatment
with antitubercular drugs.
 PLANNING :
 ATT – ANTI-TUBERCULAR THERAPY.
 To treat the higher levels of the serum creatinine as the patient had past
history of the ERSD.
 GOALS OF TREATMENT:
 To treat the tuberculi infection.
 To normalize the serum creatinine levels.

15. NAME OF THE
MEDICATION
DOSE FREQUENCY ROA USES
INJ. PAN 40mg OD IV Reduces the excess acid in the
stomach
INJ. COLISTIN 1mg BD IV Antibiotic
INJ. INH 300mg OD IV Used in the treatment of the
tuberculosis
(Anti Tubercular drug)
T.COMBUTOL 500mg Alt day PO Used in the treatment of tuberculi
infection.
(Anti Tubercular drug)
T. SHELECAL 500mg TID PO Treat the vitamin D3 deficiency
T.CERVIFIN 500mg TID PO Used treat the nasal congestion,
cough
Patient Current Therapy

16. NAME OF THE
MEDICATION
DOSE FREQUENCY ROA USES
INJ.EPOFIT 6000IU TIW PO Used to treat
anaemia caused
due to severe
kidney disease.
T.IVABRAD 2.5 mg OD PO Used to treat the
shortness of breath
nasal congestion.
INJ.LEVOMAC 500mg OD PO Used to treat the
bronchitis and UTI

17.  The most serious problem with TB therapy is patient non-adherence to the prescribed
regimens.
 Written instructions or patient information leaflets (PILs)may be offered to support verbal
counselling if there is any doubt as to the patient’s understanding.
 It should be emphasized that the disease will be cured, but this will take some months and
the tablets will need to be taken as prescribed even if the patient feels better.
 Patient should aware on the adverse effects of drugs for example :
 Standard Therapy:
Rifampicin- It is highly distributed drug & it is reason for the orange-red colour of the
saliva, tears, sweat, urine. So the patient should be intimate before administration of drug.
 Ethambutol : increases the uric acid levels in blood cause hyperuricaemia.
PATIENT COUNSELLING

18.  Patient should be aware of adverse effects which may be caused if discontinued
the medication and should be aware of drug resistance.
 TB alert has produced leaflets o the treatment of the TB for patients.
 Educating the patient on the importance of activity & adequate nutrition.
 It is crucial to discuss on preventing of TB since its is a highly contagious
infection.
 Education should cover – hygiene measures, mouth care coughing mouth & nose
when sneezing, disposing of tissues properly and hand hygiene.
 Patient will probably have thick secretions that obstruct the airways and decrease
gas exchange.
 Encouraging the patient to practice ethe deep breathing & physical exercises that
reduce the shortness of breathe.