ase study on Sepsis shock

1. CASE STUDY
on
TANUSHKA
Pharm D
Sepsis shock with
thrombocytopenia hypokalemia
and hyponatremia

2. SOAP FORMAT-1
SUBJECTIVE OBJECTIVE
•Fever from last 5 days
•Pain in rgt knee ,body pain ,fatigue
last from 5 days
•Abdomen pain last from 5 days
•Not passed stool since yesterday
• Ultrasound- multifocal parenchymal
infiltrates in bilateral lower lobes of
lungs ,soft tissue swelling around
right hip joint with multiple located
,extrinsic mass effect on right side of
UB and rectum prominence of small
bowel loops
• Na: 123mEq/L
• K: 3.0 mEq/L
• ESR: 38mm/hr
• Hgb-9.3 g/dl
• RBCs-are predominantly monocytic
and monochromatic along with few
monocyte
• TLC-is reduced {thrombocytopenia}

3. ASSESSMENT
Diagnosis:
SEPSIS with shock, thrombocytopenia, hyponatremia,
hypokalemia
Etiology:
Age: 12 Sex: M Unit- PICU-2
Date of admission – 12/10/2016
Allergic to diclofenac
Indication for therapy
To resolve the sepsis condition completely
To maintain the electrolyte balance
To resolve the fever

4. GOALS
PATIENT SPECIFIC
• Fever
• Abdominal and body
pain
• Fatigue
• Constipation
• Pain in right knee
DISEASE SPECIFIC
• Hyponatremia
• Hypokalemia
• To bring the ESR in
normal range and also
bring the platelets into
normal range
• Hematic preparation
should be given

5. SEPSIS SHOCK

8. vancomycin
• Class : glycopeptide antibiotic
• MOA: inhibition of bacterial cell wall synthesis by
blocking glycopeptide polymerization through binding
tightly to D-alanyl-D- alanine portion of cell wall
precursor
• Spectum of activity: streptococci, staphylococci
(including methicillin-resistant s.aureus or beta
lactum resistant coagulase negative staphylococcus
• Side effect: nephrotoxicity thrombocytopenia
neutropenia tend to be seen during longer treatment
course.
Redman`s syndrome :infusion related reaction
slow infusion rate if occur may use diphenhydramine
for symptomatic relief .

10. Ceftriaxone
• 3 rd generation cephalosporin
• Inhibits bacterial cell wall synthesis by means of
binding to the penicillin binding protein
• Inhibition of PBPs would in turn inhibit the
traspeptidase step in peptidoglycan synthesis which is
required for bacterial cell walls {bactericidal}
• ADR : hypoprothrombinemia and bleeding are specific
side effect diarrhea hemolysis post renal failure in
children local irritation at the injections site rash may
precipitates in bile causing biliary sludge and gall
stone especially in children .

11. Clindamycin
• Inhibits protein synthesis by binding exclusively to the
50s ribosomal subunit
• Binds in close proximity to macrolides competitive
inhibition
• Clindamycin typically displays bacteriostatic activity,
but may be bactericidal when present at high
concentrations against very susceptible organisms
• Adverse effect
Git disturbance
diarrhea

12. Ranitidine
• H2 antagonists – inhibit basal ,food-stimulated and
nocturnal secretion of gastric acid after a single dose .
• They block H2 receptor in the stomach , blood
pressure and other sites
• They are competitive antagonists of histamine and are
fully reversible
• H2 antagonists distribute widely throughout the body
and are excreted mainly in the urine
• Clinical uses : peptic ulcer , zollinger-ellison syndrome
gastro esophagus reflux diseases
heart burn

13. Paracetamol
• MOA-cyclooxygenase {COX} inhibitors
• Decrease levels of prostaglandins
• Therapeutics effects :reduces pain and fever
• AE-nausea
vomiting
stomach pain
hepatotoxicity
dark urine
yellowish skin

14. Infusion DNS and KCL
• dextrose and sodium chloride Infusion , USP is a
sterile, nonpyrogenic solution for fluid and electrolyte
replenishmen and caloric supply in a single dose
container for intravenous administration. It contains
no antimicrobial agents. Composition, osmolarity, pH,
ionic concentration and caloric content
• Adverse effect : increase blood plasma volume
• Injection site –infection redness pain swelling
thrombosis febrile

15. Intervention
Moderate drug interaction
Vancomycin+dopamine = dopamine may reduce
the blood level of vancomycin .increase cardiac
output renal blood flow by the sympathomimetic
enhances the renal clearance of vancomycin
Management – Therapeutic drug monitoring
vancomycin
Drugs also induce thrombocytopenia –
vancomycin
ceftriazone

16. Monitoring parameters:
Liver and renal parameters
Hematological CBCs
Blood pressure
Fever
Respiratory rate
Pulse rate

17. PATIENT counselling
• Confirm patient identity
• Septic shock :sepsis always start off with local
infection which is caused by bacteria, fungi
,any infection might progress and lead to
sepsis.
• Sign and symptoms : confusion
High grade fever
Shortness of breathing

18. • THROMBOCYTOPENIA : low level of platelet in
blood which leads to excessive bleeding.
• Electrolyte imbalance : Disturbance in fluid and
electrolyte in this case low sodium and low
potassium level.
• Drugs
Vancomycin and clindamycin –thrice a day
both dugs act as an antibiotics
If there is decrease in the urine output or any
reaction were seen consel with physician

19. • Ceftriaxone 1.5 gm i.v. BD also act as antibiotic .
twice a day
Side effect like bleeding
• Paracetamol (30 ml {12-6-12-6} QD)-help in relifing
the pain
four time in a day
Side effect-git disturbance
hepatotoxicity
• Infusion(DNS+KCL) help in help in electrolyte
balance
• Inj.Ranitidine 30 mg i.v BD-decrease stomach acid
production
• Dopamine infusion-for low blood pressure and also
for septic shock