Ten percent of all pregnancies are complicated by hypertension (HTN).Eclampsia and preeclampsia account for about half of these cases worldwide. In 1619, Varandaeus coined the term eclampsia in a treatise on gynecology. DEFINITION: Eclampsia is defined as the clinical presentation of an unexplained seizure, convulsion, or altered mental status in the setting of the signs and symptoms of preeclampsia. It is considered a complication of severe preeclampsia. A woman with preeclampsia develops: --- high blood pressure (>140 mmHg systolic or >90 mmHg diastolic) --- protein in the urine --- swelling (edema) of the legs, hands, face or entire body.

1. PRESENTED BY: PARTH DHANANI (10BPW618) B.Pharm.Hons. BATCH E

15. INVESTIGATION DAY 1 DAY 2 Hb 6.3 8.5 TC 26,200 26,000 DC 68/17/1/12/2 73/20/2/5/0 PC ↓se 82,000 1,66,000 PT ↑se Total Control 24 sec 13.2 sec --- RBS 120 mg/dL (75-115mg/dL) --- Urea ↑se 193.47 (10-20mg/dL) --- Creatinine ↑se 8.88 (<1.5mg/dL) --- Sodium 135.26 142.37 Potassium 4.7 4.1 S.Bilirubin ↑se 1.41 (0.3-1mg/dL) --- SOPT ↑se 138.5 (0-35U/L) --- S.Ammonia 39.59 ---

16. INVESTIGATION DAY 1 DAY 2 LDH ↑se 2835 (14-26%) --- --- pH ↓se (7.38-7.44) 7.21 --- pCO2 ↑se (35-45mmhg) 52 --- PO2 ↑se (80-100mmhg) 67 --- Bicarbonate ↓se (20-30mE/L) 11 ---

19. DRUG DOSE ROA DURATION GENERIC NAME D1 D2 Inj. Pipzo 4.5 mg in 100ccNS i.v. 12hrly Piperacillin+tazobactam √ √ Inj. Metrogyl 100ml i.v. 8hrly Metronidazole √ √ Inj. Pantodac 40mg i.v. OD Pantoprazole √ √ Inj. Levepil 500mg in 100ccNS i.v. 8hrly Levetiracetam √ √ Inj. Lasix 2amp i.v. BD Furosemide √ √ Inj. FFP 250ml i.v. 8hrly Fresh frozen plasma √ √ Inj. Dopamine 2@ in 50ccNS i.v. 6hrly Dopamine √ √ Inj. Febrinil 1@ i.v. sos Paracetamol √ √ Inj. Falcigo 60mg i.v. OD Artesunate √ √ Inj. D25% 500ml i.v. 10ml/hr Dextrose √ √ Inj. Sodium bicarbonate (0.6*wt*HCO3 def.) 0.6*48*9 = 259.2mEq i.v. 13@ straight & 13@ 6hrly Bicarbonate √ √

21. DRUGS INTERACTIONS MANAGEMENT lactulose ↔ Artesunate ( moderate) Electrolyte loss and increase the risk of torsade de pointes ventricular arrhythmia. Electrolyte disturbances including hypokalemia and hypomagnesemia. The recommended dosage and duration of use should not be exceeded. Electrolye supplements needed to be administered. lumefantrine ↔ food (moderate) Coadministration with grapefruit juice may increase the plasma concentrations of artemethe. The mechanism is decreased clearance due to inhibition of CYP450 3A4-mediated first-pass metabolism in the gut wall by certain compounds present in grapefruits. Avoid the consumption of grapefruits and grapefruit juice. To ensure maximal oral absorption, artemether-lumefantrine should be taken with food. Inadequate food intake can increase the risk for recrudescence of malaria.

22. DRUGS INTERACTIONS MANAGEMENT furosemide ↔ lactulose (Moderate) Potentiate the pharmacologic effects of diuretics. Laxatives can cause significant losses of fluid and electrolytes In general, laxatives should only be used on a short-term, intermittent basis in recommended dosages. Contact physician if they experience signs and symptoms of fluid and electrolyte depletion such as dizziness, lightheadedness, dry mouth, thirst, fatigue, weakness, decreased urination, postural hypotension, and tachycardia.

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