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MENINGOENCEPHALITIS with urosepsis case presentation
- 1. PARIMALA PILLI 5TH YEAR PHARM.D 20PH102116 CasePresentation on MENINGOENCEPHALITIS
- 2. MENINGOENCEPHALITIS :- Meningitis isthe inflammation of the membranes that cover the brain and the spinal cord. Inflammation and infection of the menings is often a life threatening medical condition as it can lead to brain infection and infection in the blood stream or septicemia which can be fatal. Meningitis may be caused by bacteria or by viruses. Viral meningitis usually is more common and runs a milder course while bacterial meningitis is a medical emergency.
- 4. Causes – Bacteria Streptococcuspneumonia, Neisseria meningitides, Haemophilus influenza, E. coli, and Mycobacterium tuberculosis Viruses Herpes simplex virus type 1 (HSV1), which also causes cold sores, and enteroviruses Amoeba Naegleria fowleri, a free-living ameba that causes primary amebic Meningoencephalitis (PAM), which is usually fatal
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- 6. DEMOGRAPHIC DETAILS PATIENT NAME– Xyz AGE – 32yrs GENDER – Male DEPARTMENT – General IP NO – 608382 DOA – 11/10/24
- 7. Reason for admission:- • C/o Right loin pain radiating to groin region since 3 days. • Burning micturition / difficulty in passing urine since 2 days. H/o Pt went to outside hospital had sudden onset of vomitings 2- 3 episodes – followed by LOC. Routine investigations – S/o UROSEPSIS & SEPTICSHOCK Admitted for further evaluation and management.
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- 9. Stat Medication INJ. Noradrenalininfusion – 4ml/hr – IV IVF N.S – 500ml – 100ml/hr – IV INJ. Pan – 40mg INJ. Zofer – 4mg INJ. PCM – 1gm INJ. Levipil – 1gm INJ. Monocef – 2gm INJ. Meropenem – 2gm INJ. Acyclovir – 500mg
- 10. DAY NOTES O/E Ptis drowsy doesn’t obey commands Vitally Stable Rx :- INJ .Meropenem – 1gm IV BD INJ. Optineuron – 1amp IV BD STOP ACYCLOVIR & MONOCEF ADV :- MRI BRAIN PLAIN EEG USG ABDOMEN CT BRAIN O/E GCS – E4V5M6 Irrelevant talk BP – 110/70mmhg PR – 77bpm Obeying commands Adv :- - Remove ryes tube - Liquid diet - 4FFPs blood transfused
- 11. O/E Pt isconscious & coherent Obeying commands GCS – E4L5M6 Plan :- B/L URSL + DJ Stenting (after stabilization) Rx :- As per chart NBM after breakfast S/P B/L URSL + DJ stenting O/E Pt is c/c Vitally stable Plan:- DISCHARGE
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- 13. SUBJECTIVE DATA :- A32yrs old male pt having complaints of rt loin pain radiating to groin region since 3 days, burning micturition & difficulty in passing urine since 2 days H/O Patient went to outside hospital had sudden onset of vomiting 2 -3 episodes – followed by LOC , routine investigation s/o Urosepsis & Septic shock. Was admitted for further evaluation and management.
- 14. OBJECTIVE DATA :- LABINVESTIGATIONS MRI BRAIN PLAIN – Meningoencephalitis , tiny acute lacunar infarcts seen in rt post temporal, lt parietal lobe & in B/L post centrum semiovale with flair hyperintensity & different restriction. USG ABD – 18*3.5mm rt mild uretic calculi with hydrouretic nephrosis. Dengue NS1,Malaria :- +ve
- 15. CRP – 230.6mg/dl Cr– 2.9(mg/dl) S.Bil – 1.7(mg/dl) SGOT – 89.69(u/l) SGPT – 58.3(u/l) HB – 12.50,12.30 (g/dl) PCV – 39.60,36.80 PLT– 0.45,0.25,0.39(lakhcells/cum) PT – 23.70 sec INR – 1.80 sec S.Cl – 114 mEq/l
- 16. ASSESSMENT Based on subjectiveand objective evidences patient was diagnosed with MENINGOENCEPHALITIS UROSEPSIS / SEPTICSHOCK / AKI THROMBOCYTOPENIA
- 17. Planning :- TREATMENT GOALS:- To achieve remission. To avoid possible complications. To improve patient quality of life To reduce morbidity and mortality.
- 18. Standard Treatment :- Cefotaxime – 50mg/kg Ceftriaxone – 75mg/kg Corticosteroids Antivirals Antifungals PLAN – B/L LASER URSL + DJ STENTING
- 19. BRAND NAME GENERIC NAME CATEGORYDOSE ROA FREQUE NCY 1 Inj.Meropenem Meropene m Carbapenem 1gm IV TID 2 Inj. Doxy Doxycyclin e Tetracycline 100mg IV BD 3 Inj. Levipil Levetiracet am Antiepileptic 500mg IV BD 4 Inj .Nootropil Piracetam Antimyocloni c 3gm IV TID 5 Tab. Sibelium Flunarizine Calcium antagonist 10mg PO HS 6 Inj.Pan Pantopraz ole PPI 40mg IV OD 7 Inj. Emesit Ondansetr on Antiemetic 4mg IV BD Medication chart :-
- 20. Inj.Meropenem Generic name :–Meropenem Category :- Carbapenem, Antibiotic Indications :- Anthrax,bloodstream infections,cystic fibrosis,diabetic foot infection,meningitis,pneumonia. MOA :- Inhibits bacterial cell wall synthesis by binding to several PBP, which in turn inhibits final transpeptidation of peptidoglycan synthesis. AE :– Acute MI , bradycardia,hypervolemia,anemia,sepsis. CI :– Cabapenem allergy Dose :– 500mg every 6 hrs
- 21. Inj. Doxy Generic name:– Doxycycline Category :- Antibiotic Indications :- Acne vulgaris,actinomyosis,anthrax,cholera,malaria,otitismedia ,STDs,surgical prophylaxis. MOA :- Inhibits protein synthesis by binding to 30s & 50s ribosomes. AE :- Bonegrowth suppression, esophageal injury,photosensitivity. DI :- Antacids,calcium salts,lithium,phenytoin CI :- Hypersensitivity
- 22. Inj.Levipil Generic name :-Leviracetam Category:- Antiepileptic Indication :- craniotomy, seizure prophylaxis, focal onset seizures and generalized seizures, status epilepticus. MOA :- Inhibition of voltage dependent N-type calcium channels. Dose :- 5-10mg – OD AE:- Drowsiness,anxiety,heartburn,myalgia,weakness,nausea. CI :- Hypersensitivity DI:- Antihypertensives,CNSdepressants,carbamazepine,magn esium sulfate.
- 23. Inj. Nootropil Generic name:- Piracetam Category :-Anti myoclonus Indication :-Cognitive disorders, Cortical myoclonus, dyslexia. MOA :-The mechanism of activity in reducing symptoms of cortical myoclonus is unknown, although GABA- mimetic effects have been suggested (Wincher 2001). Modulation of AMPA-type glutamate receptors leading to increased density of binding sites for AMPA . Dose :-3gm-IV-TID AE:-Nervousness, Weight gain, Hyperkinesias CI :-cerebral hemorrhage, Hypersensitivity DI:-Thyroid Products
- 24. Tab. Sibelium Generic name:- Flunarizine Category :-Calcium channel blocker Indication :- Migraine prevention MOA :- Flunarizine is a selective calcium channel blocker that prevents cellular calcium overload by reducing excessive transmembrane calcium influx. Dose :- 10mg-PO-HS AE :- Drowsiness,anxiety,depression,dizziness CI :- Parkinsonism
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- 26. Discharge Medication :- oTab. Levera – 500mg – PO – TD o Tab. Pantocid – 40mg – PO – OD o Syp. Patklor – 10ml – PO - TID
- 27. GOALS ACHIEVED :- S/P URSL + DJ STENTING was done. Malaria/Dengue was eradicated. Improved RBC lines. Patient was obeying commands. Achieved remission. Improved patient QOL.
- 28. Patient counseling :- AboutDisease As patient was not obeying commands, about the condition of Meningoencephalitis was explained to the concerned members . Meningitis is the inflammation of the membranes that cover the brain and the spinal cord. Also explained about the possible complications - Inflammation and infection of the meninges is often a life threatening medical condition as it can lead to brain infection and infection in the blood stream or septicemia which can be fatal.
- 29. About Medication Explained aboutthe treatment plan , medication chart,roa,possible adverse affects & advised not to worry for minimal affects. Advised to seek medical help if required. Counselled patient regarding medication adherence. Explained about possible effects of drugs such as :- 1. Avoid sunlight exposure as it may lead to photosensitivity concerned with Doxycycline. If necessary use SPF lotions. 2. Extra pyramidal affects, depression , anxiety associated with Sibelium,Levipil,Piracetam. 3. Advised to focus on social being.
- 30. Lifestyle Modifications :- •Avoid alcohol consumption – counteracts & diminishes activity of drugs. • Frequent BP monitoring, get routine health checkups. • Avoid getting sick by thoroughly washing your hands before eating, and not sharing cups or silverware. •Regular exercise for about 30min daily is preferred.