A simple Case Presentation On Parkinsons disease For any queries ask me questions so I can able to clear you as much fast as I can

1. CASE PRESENTATION ON
PARKINSON’S DISEASE
SENTHIL RAJ V

2. CASE PRESENTATION ON PARKINSON’S
DISEASE
 Name : xxx
 Age/Sex: 81/Male
 DOA: 12/10/2014
 DOD: 13/10/2014

3. ADMISSION COMPLAINTS:
 Fever * 4 days.
 Cough with expectorations * 4 days
 Breathelessness * 4 days

4. HISTORY OF PRESENT ILLNESS
 80 year old male a K/C/O PTB, Parkinson’s disease & old CVA
came to the ER with C/O of Cough with Expectorations * 4
days, minimal expectorations, White colour Sputum.
 No Blood in sputum.
 No Foul Smelling.
 H/O Breathelessness * 4 days, Worsening of breathelessness
since 2 days, associated with Wheeze.
 H/O Fever present.
 No H/O Bleeding manifestations.
 No H/O Burning Micturation.
 No H/O Chest Pain.
 No H/O Loose Stools.

5. PAST MEDICAL HISTORY:
 Old CVA 6 years back.
 Parkinson’s disease *1 year.
 Old PTB 10 years back completed full course of
treatment.
 N/K/C/O HTN/BA/DM.
 Disease Condition was Mentioned, No records
were available.

6. GENERAL EXAMINATION:
 SOCIAL HISTORY:
 NIL
 PAST MEDICATION HISTORY:
 No Records Were Available.
 FAMILY HISTORY:
 NIL
 P+, NO ICCLE
 TEMP: 99 F
 PULSE: 100/MIN
 RR: 20/MIN
 BP: 120/80 mm/Hg

7. SYSTEM EXAMINATION:
 CVS:
 S1 S2. No murmurs
 CNS:
 Patient is having Tremors of both the hands.
 Moving all Four Limbs.
 No Neurological Deficits.
 RS:
 Bilateral Air entry.
 Bilateral Wheeze present.
 Right mammary crepitations present.
 Inframammary crepitations present.
 Infrascapular crepitations present.
 GU/GI:
 P/A – Soft, BS +, No Organomegaly.

8.  OTHER INVESTIGATIONS:
 Normal Chamber Dimensions
 Sclerosed Cardiac Valves
 Trivial Mitral Regurgitation
 Trivial TR with Normal PA pressure
 No Regional wall Motion Abnormality
 N/LV Systolic Function with Grade I Diastolic Dysfunction

9.  Urobilinogen – 0.2 mg/dl(0.2-1.0)
 HRCT Throax done & reported as
BRONCHIECTASIS & RIGHT ASPIRATION
PNEUMONIA

10. LABORATORY DATA
PARAMETERS LAB FINDINGS NORMAL VALUES
HB(g/dl) 13.3 (13-17)
PCV(%) 39.5 (40-50)
TC(cumm) 24600 (4000-11000)
DC - P(%)
L(%)
E(%)
M(%)
B(%)
90.6
6.6
0
2.8
0
(45-70)
(25-40)
(1-6)
(2-10)
<1
MCV (fl) 87.3 (83-101)
MCH(pg) 29.3 (27-33)
MCHC 33.6 (31.5-34.5)
PLT(lakhs/cumm) 2.47 (1.5-4)
ESR(mm/hr) 20 (4-30)
RBC(mill/cc) 4.52 (4.5-5.5)

11.  Blood sugar
 Renal Profile
 Liver Profile
 Lipid Profile
 Thyroid profile
are all found to be Normal.

12. FINAL DIAGNOSIS
 LRTI
 OLD CVA
 OLD CT
 PARKINSONS DISEASE

13. DRUG CHART
DRUGS GENERIC NAME DOSE ROUTE FREQUENCY
INJ.
CEFTRIAXONE
CEFTRIAXONE 2g IV 1-0-0
INJ PAN PANTOPRAZOLE 40mg IV 1-0-0
NEB IPRAVENT IPRATROPIUM
BROMIDE
2CC NASAL Q 6 H
NEB BUDECORT BUDESONIDE 2CC NASAL Q 8 H
T AZIWOK AZITHROMYCIN 500mg P/O 1-0-0
T SYNDOPA PLUS CARBIDOPA +
LEVODOPA
25+100
mg
P/O 1-1-1
T RASALECT RASAGILINE 0.5mg P/O 1-0-0
T DOLO PARACETAMOL 650mg P/O 1-1-1

15. GUIDELINES:
 For LRTI(Acquired Pneumonia) – AMERICAN
SOCIETY OF THORACIC SOCIETY(Guidelines on
the Management of Community Acquired
Pneumonia)
 Drug of Choice : Primary- Azithromycin
Secondary - Ceftriaxone
 For LRTI(Bronchiectacsis) – GLOBAL INITIATIVE
FOR COPD(Global Strategy For The Diagnosis,
Management, & Prevention of COPD 2014)
 Drug of Choice : Ipratropium Bromide +
Budesonide

16.  For Parkinsons disease – Parkinsons Disease
Society (The Professionals Guide to Parkinsons
Disease)
 Drug of Choice : T SYNDOPA PLUS ( CARBIDOPA
25mg+ LEVODOPA 100mg ) & Rasagiline
 For Fever - Paracetamol

17. DRUG DISCUSSION:
 Ceftriaxone
MOA: Interferes with the synthesis of bacterial
cell wall.
Adverse Effects: Hypoprothrombinaemia,
bleeding & Haemolysis.
 Pantoprazole
MOA: Proton Pump Inhibitor
Adverse Effects: Nausea, Headache, Loose
stools, Abdominal Pain

18.  Ipratropium Bromide
MOA: Bronchodilators ( Anticholinergics )
Adverse Effects: Dryness of Mouth
 Budesonide
MOA: Inhalational Corticosteriod
Adverse Effects: Oral Candidiasis, Hoarse voice,
Skin bruising

19.  Azithromycin
MOA: Inhibition of Bacterial Protein synthesis by
combining with 5os Bacterial ribosome and
interferes with translocation.
Adverse Effects: Mild gastric upset, Abdominal
Pain, Headache and dizziness.
 Rasagiline
MOA: MAO – B inhibitor (Increases the amount
of dopamine)
Adverse Effects: Dry mouth, Constipation and
Headache

20.  Levodopa + Carbidopa
MOA: Dopamine Precursor + Peripheral
Decarboxylase Inhibitor
Adverse Effects: Dyskinesia ( Uncontrolled or
Excessive Movements)

21. DRUG INTERACTIONS
 rasagiline + levodopa
 rasagiline, levodopa. Mechanism: pharmacodynamic
synergism. Potential for dangerous interaction. Use
with caution and monitor closely. Risk of acute
hypertensive episode.

22. PATIENT COUNSELLING:
 You may walk more slowly than before, but a
daily walk is good exercise and may help to
loose up stiff muscles.
 If feeling any mental illness, sickness, vertigo
and dizziness, should report to the physician.
 Make sure exactly when to take your medicine.
 Any compliance with the drug should be
reported to the physician.
 Use of mouth wash can keep away from
aspirating infections.
 Breathing exercises should be taught.

23. REFERENCE:
 AMERICAN SOCIETY OF THORACIC
SOCIETY(Guidelines on the Management of
Community Acquired Pneumonia)
 GLOBAL INITIATIVE FOR COPD(Global Strategy
For The Diagnosis, Management, & Prevention
of COPD 2014)
 Parkinsons Disease Society (The Professionals
Guide to Parkinsons Disease)
 Drug Interactions Checker ( Medscape )
 Patient.co.uk