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case presentation on leptospirisis.pptx

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case presentation on leptospirisis.pptx

  1. 1. Case presentation on leptospirisis -tick borne spotted fever with AKI and thrombocytopenia A.Pavitra 17ER1T0017 Pharm-D internship
  2. 2. Demographic details : • Name : xxxx • Age : 49yrs • Gender : male • IP no : 7843 • Date of admission : 9/10/22 • Ward :MM-5 • Physician : Dr.Sarayu Reddy
  3. 3. Chief complaints : • Fever with chills since 5 days with rash in abdomen and back of body • Headache since 5 days • 1 episode of tonic clonic seizures • Altered sensorium since 1hour Personal history : Alcoholic since 10yrs
  4. 4. Prognosis: • Day :1 • O/E pt is confused and irritable • Temp:100°F • Spo2:95% on RA • Bp130/90mm hg • PR:108/min • RR:21/min • Grbs:100mg/dl • Day 2: • O/E pt is irritable • 1 session of dialysis done • Temp:100°F • BP:108/80mm hg • PR:94/min • Gcs:E3V2M3 • Grbs-81mg/dl • U/O:Anuric • 1.Inj.Levipil-1.5g-iv-TID • 2.Inj.pcm-1gm-iv-BD • 3.Inj.pan-40mg-iv-OD • 4.Inj.Zofer-4mg-iv-BD • 5.Ivf 500ml bolus • 6.Inj.Meromac-1gm-iv-TID • 7.Inj.Doxy-100mg-iv-BD • CST • 1.Inj.Thiamine-200mg-iv-TID • 2.Inj.Lonazepam-2mg-iv-sos • 3.T.Dolo-650mg-p/o
  5. 5. • Day 3: • BP:140/90mm hg • PR:110/min • Gcs:E2V2M5 • Grbs:91mg/dl • Day 4: • O/E pt sensorium improved • 2sessions of dialysis done • U/O:Nil • PR:100/min • Spo2:94%on RA • BP:140/90mmhg • GCS:E4V5M6 • Day 5: • O/E pt is conscious and coherent • PR:99/min • BP:130/70mmhg • Spo2:97% on RA • Temp:99 F • U/O:Adequate • CST • CST • 1.Syp.Looz-30ml-po-H/S • 2.Inj.Clindamycin-600mg-iv-TID • CST • 1.T.Nephrosave-BD • 2.T.Sobosis Forte-1gm-po-BD
  6. 6. • Day 6: • Day 7: • Day 8: • Day 9: • CST • 1.Inj.Dexona-2cc-iv-stat • 2.Inj.Pcm-1gm-iv-BD • CST • 1.Inj.Decadron-2cc-iv-OD • Stop inj.dexona • Stop meromac,clindamycin,pan, • zofer,pcm,doxycycline • 1.T.faropenem-300mg-p/o-BD • 2.T.Levipil-500mg-po-BD • 3.T.Clindamycin-600mg-po-TID • 4.T.Nephrosave-p/o-BD • 5.T.Dolo-650mg-p/o-SOS • 6.T.dexa-2mg-po-OD
  7. 7. Discharge Medications: • 1.T.faropenem-300mg-p/o-BD • 2.T.Levipil-500mg-po-BD • 3.T.Clindamycin-600mg-po-TID • 4.T.Nephrosave-p/o-BD • 5.T.Dolo-650mg-p/o-SOS • 6.T.dexa-2mg-po-OD • 7.T.Pan-40mg-po-OD • 8.T.zincovit-OD • 9.T.Omnacortil-10mg-OD • 10.T.Sobosis-500mg-BD • 11.Fusibet Cream • 12.T.udiliv-300mg-BD
  8. 8. Objective Evidence
  9. 9. • Day 2&3: • Sr.K+:3.4mmol/l (3.5-5.1mmol/l) • PLT:26000L/cumm • Pro Calcitonine:15.30 (<=0.5) • CRP:253mg/l (0-6mg/l) • Blood urea:82 • Sr.Creatinine:4.5 • Serum Electrolytes: • Na+:137mmol/l (135-150mmol/l) • K+:3.3mmol/l (3.5-5.1mmol/l) • Cl-:104mmol/l (94-110mmol/l) • Usg abdomen: • Prominent in size of both kidneys with mild increased echotexture –S/O Renal Parenchymal disease • Polyp in GB(6mm) • Ecg: • Diffuse slow wave activity suggestive of encephalopathy
  10. 10. • DAY 4: • CUE: • Pus cells:2-3 • Epithelial cells:1-2 • Blood urea-72mg/dl • Creatinine-3.1mg/dl • PLT-57,000l/cumm • DAY 5: • Sr.creatinine:2mg/dl • Blood urea:62mg/dl • PLT:58,000l/cumm • CRP:39.8 • DAY 7: • PLT:71000l/cumm • Sr.creatinine:1.4 • Doppler of both LL: • Subcutaneous edema around Ankle &foot region-S/O Cellulitis
  11. 11. ABG Day 1 Day 2 Day 3 Normal Values PH 7.23 7.37 7.40 7.35-7.45 Pco2 26 27 36 35-45mmhg Po2 77 77 64 75-105mmhg Glu 108 78 127 3.5-5.4mmol/L Lac 6.9 2.0 1.3 0-2mmol/L Hco3 10.9 15.6 22.3 22-28mmol/L
  12. 12. Assessment : • Based on subjective and objective evaluation the patient was diagnosed with Leptospirosis-tick borne spotted fever with Aki and Thrombocytopenia
  13. 13. Planning: Brand Name Generic name Indication Dose ROA Frequency Duration Meromac Meropenem Antibiotic 1gm IV TID 1-8days Sobisis Forte Sodium Bicarbonate To treat metabolic acidosis 1gm IV TID 5-9days Nefrosave Acetyl cystine &pyridoxime dihydrochloride It acts as a neuroprotect ive agent 750mg Oral BD 5-9days Omnacortil Prednisolone To treat allergies & inflammatio n 10 mg Oral OD Discharge Doxycycline _ Antibiotic (drug of choice) 100mg IV BD 1-6days Zofer Ondonsetron Anti emetic 4mg IV BD 1-6days Pan Pantoprazole Proton pump inhibitor 40mg IV OD 1-6days
  14. 14. faropenem - Antibiotic 300 mg Oral BD Discharge Clindamycin - Antibiotic 600 mg Oral TID 4-8days Decadron Dexamethaso ne To treat severe allergies 2cc IV OD 6-9days Levipil Levetiraceta m To treat seizures 500 mg Oral BD 1-9days udiliv Ursodeoxych olic acid To prevent liver disorders 300 mg Oral BD Discharge Dolo Paracetamol To treat fever 650mg Oral TID 1-9days Lorazepam _ To treat anxiety and seizures 2mg IV SOS 2-6days Thiamine _ To prevent brain damage(wernick er encephalopathy) in alcohol pt’s 200mg IV TID 2-6days
  15. 15. Regarding drugs: • Meropenem: Beta Lactum Antibiotic MOA: Acts against gram +&-ve bacteria by inhibiting cell wall synthesis Side effects: bluish lips, chills, itching • Sodium bicarbonate: Alkalinizing agents MOA:To treat acid imbalance Side effects: dizziness, mood changes, vomitings • Prednisolone: Corticosteroid MOA: Decreases inflammation Side effects: weight gain, insomnia, indigestion • Doxycycline: tetracycline antibiotics MOA: Acts by protein synthesis of 30s ribosemes Side effects: headache, hives, diarrhea • Dexamethasone: Corticosteroid • MOA: To treat severe allergies • Side effects: anxiety, headache, decereased urine
  16. 16. • Clindamycin:Macrolide antibiotic MOA:Act by inhibiting protein synthesis Side effects:abdominal pain, starry stools, cloudy urine • Faropenem: Beta Lactum Antibiotic MOA: Acts by inhibiting cell wall synthesis Side effects: nausea, diarrhea, rashes • Lorazepam: Benzodiazepenes • MOA:They bind to ihbitory neurotransmitter GABA • Side effects:drowsiness, dizziness, weakness • Levipil:Anticonvulsants • MOA:It acts by modulation of synaptic neurotransmitter release through binding to the synaptic vesicle protein SV2A in the brain. • Side Effects:Dizziness, headache, irritation, nasal congestion
  17. 17. Pharmaceutical care issues : • No Drug interactions • ADR’S • Errors found
  18. 18. Definition: • Leptospirosis is an infectious disease caused by the spirochete Leptospira. • Rodents are the important reservoirs. Leptospires may enter the host through abrasions in the skin or intact mucosa, the conjunctive and the lining of oro-and naso-pharynx in contact with water contaminated with leptospira
  19. 19. Etiology:
  20. 20. Pathophysiology:
  21. 21. Signs and symptoms:
  22. 22. Diagnosis:
  23. 23. Treatment:
  24. 24. Lifestyle modifications :

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