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1. NARASARAOPET
INSTITUTE OF
PHARMACEUTICAL
SCIENCES

2. SUBJECTIVE:
A 55 years male patient was admitted in the
hospital in general ward with the chief
complaints of:
• Severe shortness of breathe .
• DM+/ HTN.

3. PMH:
• Fever
• Swelling at below left ear
PMHX:
• Not signified

4. OBJECTIVE:
Laboratory investigations:
• Blood urea-30mg/dl
• Serum creatinine-1.3mg/dl
• Total bilirubin-4.0mg/dl
• Direct bilitubin-1.8mg/dl
• SGOT-325U/L
• SGPT-366U/L
• Alkaline phosphates-143IU/L
• Serum proteins-7.0g/dl
• Serum albumin-3.8g/dl
• Globulin-3.2g/dl
• A/G ratio-1.1

5. • Potassium-2.9m.mol/l
• Epithelial cells-6-8cells/HPF
• RBS-201mg/dl
• HB-11.2g/dl
• TRBCcount-4.69million/cumm
• TWBC count-10,500cells/cumm
• Polymorphs-80%
• Lymphocytes-13%
• Eosinophils-06%
• Monocytes-01%
• Basophils-00%
• HCT-39%

6. • MCV-83.1fl
• MCH-23.9 pg/cell
• MCHC-28.7 gm/dl
• Platelet count- 79000 lakhs/cumm
• URINE FOR MICROSCOPIC EXAMINATION
• RBC- 4-6 million/cumm
• PUS cells- 6-8
• Epithelial cells- 2-4

7. SERUM ELECTROLYTES
DAY
1
DAY
2
DAY
3
DAY
4
DAY
5
DAY
6
DAY
7
DAY
8
DAY
9
DAY
10
DAY
11
Na+ 123
mm
ol/l
137
mm
ol/l
141
mm
ol/l
142
mm
ol/l
135
mm
ol/l
150
mm
ol/l
130
mm
ol/l
131
mm
ol/l
134
mm
ol/l
131
mm
ol/l
134
mm
ol/l
K+ 5.8
mm
ol/l
4.7
mm
ol/l
4.4
mm
ol/l
3.9
mm
ol/l
4.9
mm
ol/l
5.0
mm
ol/l
4.9
mm
ol/l
5.3
mm
ol/l
4.4
mm
ol/l
4.2
mm
ol/l
4.1
mm
ol/l
Cl 96 105 104 106 94 90 96 96 98 - -
FBS 139
mg/
dl
248
mg/
dl
77
mg/
dl
114
mg/
dl
211
mg/
dl
140
mg/
dl
250
mg/
dl
260
mg/
dl
182
mg/
dl
177
mg/
dl
127
mg/
dl

8. ECG
• No RWMA of LV
• Good LV systolic function
• Reduced LV complaints
• Normal sized chambers
• Sinus tachycardia
• Increased flows across all valves

9. DIAGNOSIS
• Severe SOB
• DM+ / HTN

10. ASSESMENT
VITALS:
DAY1
Temp- 101ºF
BP- 130/80 mm of Hg
HR- 150 bpm
SPO2- 84%

11. S.NO Drug Dose ROA Frequenc
y
1. Pantop 40 mg IV OD
2. Periset 8 mg IV Stat
3. Meromac 1 gm IV TID
4. Falcigo 120 mg IV Stat
5. Tab.Doxy 100 mg Oral BD
6. Clindamycin 600 mg IV TID
7. Tab. Udiliv 300 mg Oral TID
8. Hepamerg 2
cy/100
mg
IV TID
9. Optineuron 1 AMP IV OD
10. IVF

12. S.NO DRUG DOSE ROA FREQUENCY
11. Vec 30mg+20ml IV 2ml/hr
12. Syr. Lactulose 20ml Oral TID
13. Tab. Ivuhrual 7.5mg Oral BID
14. Inj. Vit.K OD
15. Syr. portlor 10ml Oral TID
16. RT Feeds 150ml 2nd hrly
17. Inj. Azithral 500mg IV BID
18. Inj. Solmedrol 40mg IV BID
19. Tab. Folivite 5mg Oral BID
20. Inj. Nakisl 15ml IV BID
21. Inj. Lasix lamp IV/stat BID

13. DAY-2 Vitals
• Temp - N
• BP - 100/70
• Spo2 - 97%
• HR - 86 bpm
• RR - 18 cycles
• CVS - s1 s2+
• Lungs - crepts+
• U/O - 50ml/hr
CST

14. ADVICE
• Some drugs are excluded
( IV.VEC, Portlor-syp).
Some drugs are included
1. Inj. H. Albumin 100ml stat
2. Inj. Insugen 'R' s/c 4rth hrly
3. IV. NaHco3 50ml stat

15. DAY-3
• Temp - N
• BP - 140/90
• HR - 88
• SPo2 - 96
• CVS - S1 S2 +
• Lungs - Crepts +
• U/O - 100ml/hr
• CST

16. ADVICE
• Some drugs are excluded
( Ivuhrual, Nakil, Lasix, NaHco3 )
Some drugs are included
1. T. Ivabrad 5mg BD
2. Albumin care powder 2tsp BD
3. T. Dytor plus (10+50) 1/2 OD
4. Inj. Vecuorinum+Midaz @ 2cc/hr

17. DAY-4
• Tepm - N
• BP - 130/90
• HR - 84
• Spo2 - 99
• CVS - S1 S2+
• Lungs - Crepts+
• U/O - 150ml/hr
CST

18. ADVICE
• Excluded drugs ( Albumin care powder ).
• Included drugs
T. stamlo 5mg BD

19. DAY-5
• Temp - N
• BP - 140/90
• HR - 90
• Spo2 - 99
• CVS - S1 S2 +
• Lungs - B/L crepts+
• U/O - 100ml/hr
CST

20. ADVICE
• Excluded drugs (udiliv, hepamerz, Vit.K,
Dytorplus, Vecuorinum+midaz)
• Indluded
1. Inj. Midar 2 cc sos

21. DAY-6
• Temp - N
• BP - 140/80
• HR - 117
• SPo2 - 97%
• RR - 24
• CVS - S1 S2+
• Lungs - Crepts+
• U/O - 125ml/hr
•
CST

22. ADVICE
• Included
T. Malarid DS 15mg

23. DAY-7
• Temp - N
• BP - 120/80
• CVS - S1 S2+
• Lungs - Crepts+
• Spo2 - 100%
• U/O - 50ml/hr
• HR - 64
• RR - 26
• CST

24. ADVICE
• Exclude (midar)
• Include
Nexitoplus OD

25. DAY-8
• Temp - N
• BP - 140/90
• HR - 89
• Spo2 - 100
• CVS - S1 S2 +
• Lungs - Mild crepts +
• U/O - 100ml/hr
• CST

26. ADVICE
• Exclude ( RT Feeds, Malarid)
• Included
Amikacin 500mg IV BD

27. DAY-9
• Temp - N
• BP - 140/90
• Spo2 - 91
• U/O - good
• Lungs - B/L crepts
• HR - 92
• RR - 24
• CVS - S1 S2 +
CST

28. DAY-10
• Temp - N
• BP - 140/90
• CVS - S1 S2 +
• Spo2 - 95%
• P/A - Soft
• U/O - good
• HR - 76
• Lungs - crepts+
CST

29. ADVICE
• Exclude (Meromac, Clindamycin,
Solmedrol, Amikacin)
• Include
T. Larinate Kit as per dosage

30. DAY-11
• Temp - N
• BP - 120/80
• HR - 69
• CVS - S1 S2+
• Lungs - B/L crepts+
• U/O - Passed
• Spo2 - 98%
CST

31. ADVICE
• Excluded (Falcigo, Follivite, Pehaqenolic)
• Included
T. Dumem ER 300mg BD
IV. Fluids NS 75ml/hr

32. Subjective
C/O:-
Severe sob
DM+ / HTN
Fever
• Objective
Serum creatinine - 1.3mg/dl ↑
Total Bilirubin - 4mg/dl ↑
Direct Bilirubin - 1.8mg/dl ↑
SGOT - 325 U/T ↑
SGPT - 366 U/T ↑
Alkaline phosphatase - 143IU/L ↑
Potassium - 2.9 m.mol/l ↓
RBS - 201mg/dl ↑
WBC - 10,500 cells/cumm ↑
Neutrophils - 80% ↑
Lymphocytes - 13% ↓
Na - 123 m.mol/l ↓
Cl - 96 ↓
FBS - 139 ↑