CASE PRESENTATION ON

CHRONIC KIDNEY DISEASE

Presenting By
B.Nagamani
Pharm.D III year

Guide
P.Ramakrishna
Asst.prof .in pharmacy practice

contents

Patient Details

Chief complaints And Past History

Diagnosis

Examination And Lab Investigation

SOAP ANALYSIS

Pharmaceutical issues

Suggestions and patient education

PATIENT DETAILS

AGE-83 YEARS

SEX- FEMALE

RELIGION-HINDU

REG.NO-2012120090

Ward-C

D.O.A:13-3-14

D.O.D:17-3-14

CHIEF COMPLAINTS

The patient was admitted with the complaints of joint pains, bilateral pedal
oedema since 10 days.

She is also suffering from shortness of breath since 5 days.

PAST HISTORY

She had a past medical history of hypertension (amlodipine) and diabetes

since 15 years.

EXAMINATIONS

B.P-140/90mmHg

P.R-88/minute

R.R-24/minute

G.R.B.S-200mg/dl

LAB INVESTIGATIONS
13/03/2014

INVESTIGATION

NORMAL VALUE

RESULT VALUE

HEAMOGLOBIN%

Male-11-16mg/dl
Female-11-14mg/dl

8mg/dl

SERUM CREATININE

0.6-1.4mg/dl

6.7mg/dl

BLOOD UREA

14-45mg/dl

95mg/dl

FASTING BLOOD SUGAR

70-110mg/dl

65mg/dl

POST LUNCH BLOOD SUGAR

70-150mg/dl

285mg/dl

LAB INVESTIGATIONS
14/03/2014

INVESTIGATION

NORMAL VALUE

RESULT VALUE

SERUM CREATININE

0.6-1.4mg/dl

6.7mg/dl

16/03/2014
INVESTIGATION

NORMAL VALUE

RESULT VALUE

SERUM CREATININE

0.6-1.4mg/dl

4.4mg/dl

DIAGNOSIS
CHORONIC KIDNEY
DISEASE

SOAP ANALYSIS
PROBLEMS IDENTIFIED: Chronic kidney disease
S.O.A.P ANALYSIS:
SUBJECTIVE ANALYSIS: General weakness, joint pains, bilateral pedal oedema.
OBJECTIVE EVIDENCES: 13/03/2014
INVESTIGATION

NORMAL VALUE

RESULT VALUE

HEAMOGLOBIN%

Male-11-16mg/dl
Female-11-14mg/dl

8mg/dl

SERUM CREATININE

0.6-1.4mg/dl

6.7mg/dl

BLOOD UREA

14-45mg/dl

95mg/dl

FASTING BLOOD SUGAR

70-110mg/dl

65mg/dl

POST LUNCH BLOOD SUGAR

70-150mg/dl

285mg/dl

14/032014

INVESTIGATION

NORMAL VALUE

RESULT VALUE

SERUM CREATININE

0.6-1.4mg/dl

6.7mg/dl

INVESTIGATION

NORMAL VALUE

RESULT VALUE

SERUM CREATININE

0.6-1.4mg/dl

4.4mg/dl

BLOOD UREA

14-45mg/dl

73mg/dl

16/03/2014

ASSESSMENT: Based on both subjective evidences& objective

evidences we can assess that the patient was suffering from chronic
kidney disease.

PHARMACEUTICAL CARE PLAN

TREATMENT OPTIONS
DRUG GENERIC
NAME

DRUG BRAND
NAME

DOSE

FREQUENCY

CATAGORY

DURATION

INJ.INSULIN

INJ.H. MIXTARD

30-10-15
IU

TID

ANTI-DIABETIC

DAY1 TO DAY5

TAB.AMLODIPINE

TAB.STAMLO

5mg

OD

CALCIUM CHANNEL BLOCKER DAY1 TO DAY5

TAB.METAPROLOL TAB.PROLOMETSUCCINATE
XL

50mg

OD

-BLOCKER

DAY1 TO DAY5

TAB.DINITRO
GLYCERIN

TAB.SORBITRATE

10mg

TID

VASODILATER

DAY1 TO DAY5

TAB. VITAMINS &

MINERALS

TAB.SUPRADYN

OD

MULTI VITAMINES

DAY1 TO DAY5

TAB.CALCIUM

TAB.SHALCAL

500mg

OD

MULTI VITAMINES

DAY1 TO DAY5

INJ. Piperacillin
+ Tazobactam

INJ.REVOTY

2.25mg

BD

ANTIBIOTIC

DAY1 ONLY

INJ.GLIMEPIRIDE

INJ.UNOTAZ

4.5gms

BD

ANTI-DIABETIC

DAY2 TO DAY5

DRUG GENERIC
NAME

DRUG BRAND
NAME

DOSE

FREQUENCY

CATAGORY

DURATION

TAB.FUROSIMIDE

TAB.LASIX

20mg

BD

LOOP DIURETICS

DAY1 TO DAY5

INJ.RECOMBINETE
ERYTHROPOITIN

INJ.EPOFIT

6000 IU

ONCE A WEEK

ERYTHROPOITICS

DAY2

DISCHARGE MEDICATION

DRUG GENERIC
NAME

DRUG BRAND
NAME

DOSE

FREQUENCY

CATAGORY

DURATION

TAB.AMLODIPINE

TAB.STAMLO

5mg

OD

CALCIUM CHANNEL BLOCKER

5 days

TAB.FUROSIMIDE

TAB.LASIX

20mg

BD

LOOP DIURETICS

5days

TAB.DINITRO
GLYCERIN

TAB.SORBITRATE

10mg

TID

VASODILATER

5days

INJ.RECOMBINET
E
ERYTHROPOITIN

INJ.EPOFIT

6000 IU

ONCE A WEEK

ERYTHROPOITICS

5days

TAB. VITAMINS &

MINERALS

TAB.SUPRADYN

OD

MULTI VITAMINES

5days

OD

ANALGESIC+ANTI LIPIDIMICS

5days

TAB.ASPIRIN+ATO TAB.ECOSPRIN AV
RVASTATIN

75mg

Pharmaceutical issues
Aspirin + Metoprolol

aspirin decreases effects of metoprolol by pharmacodynamic antagonism. Significant

interaction possible, monitor closely. Long term (>1 wk) NSAID use. NSAIDs decrease
prostaglandin synthesis.

metoprolol and aspirin both increase serum potassium. Potential for interaction, monitor.

Metoprolol + Furosemide

metoprolol increases and furosemide decreases serum potassium. Effect of interaction is not
clear, use caution. Potential for interaction, monitor.

Aspirin + Furosemide

aspirin increases and furosemide decreases serum potassium. Effect of interaction is not clear,
use caution. Potential for interaction, monitor.

High doses of glimepride was given to the patient but high doses should not be given to the
patient having DM because it causes hypoglycaemia.

Suggestions and patient education

As the patient was suffering with diabetes mellitus advised to maintain foot
care.

Advised to follow regular medication as directed by the physician.

Patient was explained about all the disease that she was suffering with.

Patient must take low fat containing foods.

Life style modifications

The patient is advised to take more calcium rich diet.

Patient also advised to take meals in multiple time with small amount

Patient advised not to do heavier works the may cause hypertension.

Patient was adviced to take low salt containing foods as she was suffering
from hypertension.

THANK U ALL