case presentation on urosepsis

1. CASE PRESENTATION ON UROSEPSIS
 Submitted by:
NEWTAN DEB
18WJ1T0014
PHARM.D 5TH YEAR

2. DEMOGRAPHIC DETAILS:
 Patient name: mr.xyz
 Age: 72 year.
 Sex: M.
 DOA: 21.01.23
 DEPT. MICU
SYSTEMIC EXAMINATION:
Patient conscious,obeying commands
CVS: s1s2+ ( no murmurs)
RS: BAE+
P/A : tender+, left lower quadrant

3. SUBJECTIVE
DATA:
A 73 years old male patient presented ER dept.
with chief complaints,
c/o high grade fever with chills
c/o left lower quadrant pain and 3 episode of
vomiting nonbilious
c/o gen weakness, decreased appetite
No H/O chest pain, loos stools, cough, SOB,
Dsability: E4V3M6
PAST MEDICAL HISTORY:
seizure
 CHF, DCMP(Dilated cardiomyopathy) , sev LVSD
(Left ventricular systolic dysfunction)
 ILD, HTN,T2 DM
 Large artery disease

4. Brand name Generic name ROA
DOSE
INDICATION
INJ PANTOP PANTOPRAZOLE 40 MG ACIDITY
INJ PCM PERACETAMOL 1 G FEVER
INJ ZOFER ONDANSETRON 4 MG VOMITING
INJ HAI INSULIN 10 IU DIABETIS
INJ PIPTAZ PIPERACILLIN/
TAZOBECTAM
4.5GM UTI SEPSIS
OPTINEURON VITAMIN 1 AMP VITAMIN SUPPLY
TREATMENT IN ER

5. VITALS :
DATE 21/01/23 2212023 231202 2412023 25/1/23 26/1/23
BLOOD PRESSURE(120/80
mmhg)
140/90 170/90 118/69 120/69 118/49 163/70
HEART RATE ( 70-100
BPM)
111 92 92 89 108 99
RESPIRATORY RATE ( 12-
20/ MIN)
20 24 24 22 24 24
SPO2 98 99 100 98 98 99
TEMP. 101 99.1 101.9 100 100.2 99.7
APACHE II SCORE 24
SOFA SCORE 9

6. OBJECTIVE DATA:
DATE 21/1/23 22/1/23 23/1/23 24/1/23 25/1/23 26/1/23
Sodium
( 135-146meq/I) 133 134 142 148 150 146
Potassium
( 3.5-5.1meq/I)
4.4 4.9 3.8 3.4 3.1 4.3
Chloride
( 95-105 meq/I)
103 107 103 106 108 104
RBS(<160 mg/dl) 378 367 343 275 340 277
Calcium(8.4-
10.2mg/dl)
8.6
Mg(1.7-2.2) 1.70
Phosphorus(2.8-4.5) 4.80
creatinine 3.04 3.90 4.45 4.91 5.53 3.87
Blood urea(6-24mg/dl) 94 123 153 177 204 233

7. CBP :
DATE 21/1/23 22/1/23 23/1/23 24/1/23 25/1/23 26/1/23
Hb ( M –
14.3-
18g/dl)
9.3 9.3 7.2 8.3(PRBC) 8.1 8.2
PCV(35-
50g%)
27 22 22 24 24 24
RBC(3.8-
4.8ml/m3)
2.9 2.2 2.3 2.6 2.5 2.6
WBC
COUNT(400
0-
11000cells/
m3
25200 25200 15200 19500 17000 13000
PLATELET(1
.5-
4.0lac/m3)
1.9 1.3 78000 83000 79000 80000
ESR<20mm1
st hr
80

9.  CT BRAIN
 Chronic infarcts in right cerebellum and frontal as described.
 Moderate dilatation of ventricular system which appears to be disproportionate to the size of sulcal spaces
- NPH.
 No evidence of acute infarct / hemorrhage.
CT SCAN:
 Focal hypodensity involving the gray and white matter of right posterior parietal lobe.Likely acute infarct.
 No evidence of intra / extra axial hemorrhage
EEG REPORT:
The EEG record is suggestive of diffuse cerebral pathology
MICROBIOLOGY:
Blood culture( left brachial): E. Coli isolated
Blood culture (right femoral): E.coli Isolated
Urine culture : E.Coli Isolated
HRCT CHEST:
Subpleural dependent opacities in bilateral lower lobes –CO RADS 1

10.  CT ABDOMEN
 Contracted gall bladder with multiple calculi with minimal pericholecystic fat stranding-
Forclinical/Ultrasound correlation
 Dilated CBD with no obvious IHBRD.
 Mild dilatation of left pelvicalyceal system with perinephric fat stranding and thickening of renal
fascia - Likely pyelonephritis-To correlate with CUE.
 Left inguinal hernia as described.

11. ASSESSMENT:
Based on the subjective and objective evidences the patient diagnosed with
UROSEPSIS

12. DAYWISE ASSESSMENT:
DAY-1
c/o-
Fever
Abdominal pain
Vomiting
Decreased sensorium
•
BP-140/90mmHg
HR-112bpm
SPO2- 95%
TEMP- 101 F
DAY-2
C/O
Fever
Abdominal pain
Vomiting
Decreased sensorium
BP-140/60mmHg
HR-68bpm
SPO2- 100%
TEMP- 100 F
PLAN: intubate

13. DAYWISE ASSESSMENT:
DAY-3
c/o
Fever
Abdominal pain
Sepsis
BP-116/85mmHg
HR-92bpm
SPO2- 100%
PLAN-
1 PRBC
DAY-4
c/o
Fever
Abdominal pain
Sepsis
AKI
BP-110/50mmHg
HR-105bpm
SPO2- 99%
PLAN:
dialysis

14. DAYWISE ASSESSMENT:
DAY-5
c/o
Metabolic encephalopathy
Sepsis
AKI
Coagulopathy
BP-110/50mmHg
HR-105bpm
SPO2- 99%

15. Brand name Generic name ROA
DOSE
FREQU
ENCY
INDICATION DA
Y1
DA
Y2
DA
Y3
DA
Y4
DA
Y5
DA
Y6
INJ MEROPENEM MEROPENEM 500mg
IV
BD FOR E.COLI INFECTION      
INJ PAN PANTOPRAZOLE 40 MG OD ANTACID    
INJ OPTINEURON MULTIVITAMIN 1 AMP OD PREVENT VIT. DEFICIENCY      
INJ THIAMIN VITAMIN B1 500MG OD TURN FOOD TO ENERGY      
T. LEVERA LEVETRACETAM 1 G BD EPILEPSY    
T. SYNDOPA PLUS LEVODOPA +
CARBIDOPA
120
MF
QID USED FOR STIFFNESS &
SLOWNESS OF MOVEMENT
     
T. LACOSAM LACOSAMIDE 100MG BD CONTROL EPILEPSY      
INJ VIT.K VIT K 1 AMP OD NEED FOR BLOOD CLOT    
T.THYRONORM THYROXIN 50MG od HYPOTHYROIDISM     
INJ PCM PARACETAMOL 500mg OD FEVER     
INJ METROGYL METRONIDAZOLE 500mg TID Anerobic coverage    
ING ACTRAPID HUMAN INSULIN 40IU BD HYPERGLYCEMIA      
INJ NORAD NORADRENALIN 2ml/h sos Hypotension    

16. Brand name Generic name ROA
DOSE
FREQU
ENCY
INDICATION DA
Y1
DA
Y2
DA
Y3
DA
Y4
DA
Y5
DA
Y6
INJ ATRACURIUM ATRACURIUM BESYLATE 5ML FOR INTUBATION  
INJ FOSFOMYCIN FOSFOMYCIN 4 GM BD SEPSIS   
INJ HYDROCORT HYDROCORTISONE 50MG QID INFLAMMATION    
DAROLAC FORTE PROBIOTIC & ZINC DIGESTION   
INJ MIDAZ MIDAZOLAM 4 MG RELIVE ANXIETY 
INJ SODA BICARB SODA BICARBONATE 100
ML
METABOLIC
ACIDOSIS
 
T. LEVERA LEVETRACETAM 500MG BD EPILEPSY  
INJ KCL POTASSIUM CHLORIDE 40MG  
INJ EPOFIT ERYTHROPOIETIN 4000
U
POST
HD
ANEMIA  
INJ EIDO SUPPLEMENT NEUTRITIONAL
SUPPLEMENT
 
T. ATORVAS ATORVASTATIN 50MG HS CHOLESTEROL  
INJ LACARNIT LEVOCARNITINE 1 AMP POST
HD
HELP TO PRODUCE
ENERGY
 

17. DRUG INTERACTIONS
 LEVETRACETAM+ CARBIDOPA/LEVODOPA
 SEVERITY: MODERATE
 The use of central nervous system depressants may potentiate the effects of another drug in the same
class. The concomitant use of opioids, including certain cough medications, with benzodiazepines, or
other CNS depressants, including alcohol, may result in profound sedation, respiratory depression, coma,
and death. Observational studies have demonstrated that concomitant use of opioid analgesics and
benzodiazepines increases the risk of drug-related mortality compared to use of opioids alone. Because of
similar pharmacologic properties, it is reasonable to expect similar risk with concomitant use of opioid
cough medications and benzodiazepines, other CNS depressants, or alcohol. The risk of CNS depression
resulting from the combination of central nervous system depressant drugs varies according to the degree
of sedation from each agent. Effects may range from mild sedation to severe and lethal
respiratory/cardiovascular depression.

18.  LEVETRACETAM+ LACOSAMIDE
 SEVERITY: MODERATE
 The use of central nervous system depressants may potentiate the effects of
another drug in the same class. The concomitant use of opioids, including
certain cough medications, with benzodiazepines, or other CNS depressants,
including alcohol, may result in profound sedation, respiratory depression,
coma, and death. Observational studies have demonstrated that concomitant
use of opioid analgesics and benzodiazepines increases the risk of drug-related
mortality compared to use of opioids alone. Because of similar pharmacologic
properties, it is reasonable to expect similar risk with concomitant use of opioid
cough medications and benzodiazepines, other CNS depressants, or alcohol. The
risk of CNS depression resulting from the combination of central nervous system
depressant drugs varies according to the degree of sedation from each agent.
Effects may range from mild sedation to severe and lethal
respiratory/cardiovascular depression.

19. PATIENT
COUNSELLING:
 Take all the medications in time without skipping any
dose.
 Eat healthy diet
 Drink plenty of fluid
 Don’t skip any antibiotic
 Avoid acidic juices
 Maintain hygiene
 Avoid high salt content foods and not to add salt.
 Avoid alcohol or moderate alcohol consumption
(abstinence in alcohol related cardiomyopathy)
 Do not use any products that contain nicotine or tobacco,
such as cigarettes, e-cigarettes, and chewing tobacco.
 Avoid – food with added sugars, processed food and fried
food.
 Keep all follow-up visits to your health care provider.

20. REFERENCE:
 Lexicomp app
 Drung Bank
 medscape
 https://manual.jointcommission.org/releases/TJC2016A/DataElem0439.html