FIRST ESTABLISHED IN 1999 FIRST CORPORATE HOSPITAL IN GUJARAT, SUCCESSFULLY RENDERING SERVICES FOR LAST ELEVEN YEARS MULTISPECIALITY CLINICS IN ONE ROOF IT HAS SERVED LARGE NUMBER OF PATIENTS OF GUJARAT, RAJASTHAN AND MADYAPRADESH STATE AND PROVIDED SUITABLE PLATFORM FOR DOCTORS TO WORK IN HARMONY

1. PRESENTED BY, PARTH DHANANI 10 B P W 618 B.Pharm [ Hons.] BATCH: E

12. DAY 1 DAY 2 DAY 3 Haemoglobin 14.7 12.6 --- Total count 14,900 11,400 --- Platelet count 2,33,000 2,46,000 2,37,000 RBS ↑se 425 (70-110) --- --- Creatinine 0.8 (0.6-1.2) 0.52 --- Urea 13.5 14.2 --- Sodium 137 139.33 --- Potassium ↓se 3.0 2.8 3.1 Calcium --- 8.3 --- SGPT ↑se 125 (0 - 35) --- 80.76 Serum Amylase ↑se 2415(35-120) --- --- Serum lipase ↑se 5580 (0-160) 1520 --- Serum AlkPo4ase --- 71 (70-120) 124.99

14. DRUG GENERIC NAME DAY 1 DAY 2 DAY 3 Inj. Magnex forte (3g) IN 100ccNS i.v. 12 hrly Cefoperazone+ salbectam √ √ √ Inj. H.Actrapid acc S/C 6 hrly Short acting insulin √ √ √ Inj. Pantodac (40mg) i.v. OD Pantoprazole √ √ √ Inj. Emeset 1 @ i.v. 8 hrly Ondansetron √ √ √ Inj. Contramol 1@(50mg) in 100ccNS i.v. 8 hrly Tramadol √ √ √ Inj. 150 ml RL 1@ at 200ml/hr Ringer Lactate √ √ √ Inj. KCl 1@ in 1NS@ , 2@/day Potassium √ √ √ Inj. Febrinil 1@ i.v. sos Paracetamol √ √ √

15. DRUGS INTERACTIONS MANAGEMENT Ondansetron ↔ Tramadol Concurrent use of 5-HT3 receptor antagonists may reduce the analgesic efficacy of tramadol. The proposed mechanism is antagonism of serotonin-mediated effects of tramadol at the spinal level. No particular intervention is required. However, the possibility of a diminished therapeutic response to tramadol should be considered during concomitant therapy with 5-HT3 receptor antagonists. Insulin ↔ lvp solution with potassium (KCl in NS) Potassium repletion may partially or completely reverse glucose intolerance in some patients with liver cirrhosis. The effect of insulin may be potentiated, and the risk of hypoglycemia increased. If coadministered, close monitoring of blood glucose level is required.

21. DAY 1 DAY 2 Haemoglobin ↓se 12.1 12.9 Total count 5900 5568 ESR 05 (1–25mm/hr) --- Platelet count 2,67,000 3,12,000 RBS ↑se 158.8 (70 – 110) 179.03 Creatinine 0.7 0.67 Urea 17 14 Sodium ↓se 125.3 135.9 Potassium 3.31 2.97 SGPT 16 (0 – 35 U/L) --- pH ↓se 7.19 (7.38) --- pCO2 38 (35-45) --- pO2 ↓se 67 (80-100) --- Bicarbonate ↓se 14 (21-30 Meq/L) 16.6 CPK MB ↑se 33.99 (0-7ng/L) 24.03 Troponon I ↑se 10.5 (0-0.4) 6.1

23. DRUG GENERIC NAME DAY 1 DAY 2 DAY3 DAY4 DAY5 DAY6 Tab. Clavix (75mg) BD Clopidogrel √ √ √ √ √ √ Tab. Ecospin (150mg) OD Aspirin √ √ √ √ √ √ Inj. NTG 50mg in 50ml NS 1ml/hr Nitroglycerin √ √ √ √ √ --- Tab. Indur (30mg) 1-1-0 Isosrbide mononitrate --- --- --- --- --- √ Tab. Betaloc 50mg BD Metoprolol √ √ √ √ √ √ Tab. Atorva (40mg) 1HS Atorvastatin √ √ √ √ √ √ Tab. Ramace (2.5mg) 1 OD Ramipril √ √ √ √ √ √ Inj. Lasix 2amp. i.v. BD Furosemide √ √ --- --- --- --- Tab. Lasilactone (20+50) 1-1-0 Furosemide + Spironolactone --- --- √ √ √ √ Inj. Clexane (0.6mg) s.c. BD Low Mol.Wt. Heparin √ √ √ √ √ --- Liq. Looz 10ml HS Lactulose √ √ √ √ √ √

24. DRUG GENERIC NAME DAY 1 DAY 2 DAY3 DAY4 DAY5 DAY6 Tab. Alprex (0.5mg) 1 HS Alprazolam √ √ √ √ √ √ Inj. KCl 3amp. In 50ccNS 2ml/hr Potassium supplement --- √ √ √ √ √ Inj. Actrapid according to RBS Short acting insulin √ √ √ √ √ √

25. DRUGS INTERACTIONS MANAGEMENT Furosemide ↔ Metoprolol Diuretics and beta-blockers may increase the risk of hyperglycemia and hypertriglyceridemia in patients with diabetes or latent diabetes. Monitoring of serum potassium levels, blood pressure, and blood glucose is recommended during coadministration. Metoprolol ↔ Insulin Inhibition of catecholamine-mediated glycogenolysis and glucose mobilization in association with beta-blockade can potentiate insulin-induced hypoglycemia in diabetics and delay the recovery of normal blood glucose levels. Prolonged and severe hypoglycemia may occur. Patient should be instructed about the need for regular monitoring of blood glucose levels and be aware that certain symptoms of hypoglycemia such as tremors and tachycardia may be masked. Furosemide ↔ Ramipril Coadministration makes hypotension and hypovolemia more likely than does either drug alone. Some ACE inhibitors may attenuate the increase in the urinary excretion of sodium caused by some loop diuretics. The possibility of first-dose hypotensive effects may be minimized by initiating therapy with small doses of the ACE inhibitor, or either discontinuing the diuretic temporarily or increasing the salt intake approximately one week prior to initiating an ACE inhibitor. Heparin ↔ Nitroglycerin Concurrent administration of heparin and intravenous nitroglycerin may lead to a decreased anticoagulant effect. If coadministered, close evaluation of the coagulation status of the patient is required and heparin dose titrated as needed.

30. DAY 1 DAY 2 DAY 3 DAY 4 Haemoglobin 11.8 10.1 8 9 Total count 3360 7900 6100 5130 Platelet count 2,33,000 (1,30,000—4,00,000) 2,46,000 2,37,000 2,41,000 Creatinine 0.89 1.20 --- --- Urea 13.5 14.2 --- --- Sodium 137 139.33 --- --- Potassium 4.7 3.68 3.75 --- Calcium --- 8 --- --- Chloride ↓se 4.37 (95-105) 4.89 --- --- SGPT ↑se 118.9 113 63.65 --- Serum Amylase ↑se 2415 --- --- --- Serum lipase ↑se 5580 1520 --- --- Serum AlkPo4ase --- 78 (30-120) 118.6 ---

32. DRUG GENERIC NAME DAY 1 DAY 2 DAY 3 Inj. Magnex forte (1.5g) i.v. 8 hrly Cefoperazone+ salbectam √ √ √ Inj. Pantodac (40mg) 1@ i.v. OD Pantoprazole √ √ √ Inj. Emeset 1 @ i.v. 8 hrly Ondansetron √ √ √ Inj. Contramol 1@(50mg) in 100ccNS i.v. sos for pain Tramadol √ √ √ DNS 500ml i.v. Dextrose √ --- --- DNS/RL 1@ i.v. 150ml/hr --- √ √ NS 120ml i.v. Chloride √ √ √ Inj. Febrinil 1@ i.v. sos Paracetamol √ √ √