UNIVERSITY OF GEZIRA FACULTY OF PHARMACY BATCH

30

Case Presentation

 Done

by :

1- Sara Osman . 2- Inas Seif-eldein . 3- Mariam Fadol almawla . 4- Walaa Abdalbage . 5- Fatima Awad . 6- Samar Omer . 7- Wafaa Mubarak . 8- Alaa Hassan .

Patient bio-data :
Name : A.A.A. Age : 29 years . Gender : female . Weight : _ . Height : _ . Resident : Hussein Alkhwalda . Occupation : H.W. D.O.A. : 18/April/2011 .

Chief complaint :

L . L. swelling / 3 months .

History of present illness :

The condition started 3 months prior to admission (PTA) with L.L.swelling increasing gradually in size .

Past medical history :

Not known to be hypertensive , diabetic , or asthmatic . Known condition of hypothyroidism for 5 years .

Past surgical history :

No past surgical history .

Past medication history :

Drug Thyroxine

Indication Hypothyroidism

Dose/ frequency 50g/OD

Start (date) 5 years

Stop _

Prescriber _

Family and social history :

Family history: No family history for hypertension , DM , asthma , or any similar condition. Social history : moderate social economic status , H.W. , university educated . Not smoker or alcoholic .

Allergies :

Not allergic to any drugs known to her .

Physical examination :

Pulse rate : 80 pulse/min . B.P. : 140/100 . Not P. , J. , C. . Pt. Looks unwell , conscious , oriented to place personal , and time .

Review of system on admission :

Chest : NAD . Abdominal : NAD . CVS : NAD . CNS : NAD . O. bs. E. : NAD . P.V. : NAD Blood grouping : o (-ve).

Lab. Tests and investigations results :

RENAL FUNCTION TEST :
Test Urea S, creatinine Result 23 0,8 Normal reference 15 _ 45 Up to 1.4

Albumin
Pus cells

+++
6_8

Nil
>12

LIVER FUNCTION TEST

Test Cholesterol TG T.S. protein S. Albumin S. Globulin T.S. Biliuribin C.S. Biliuribin S. Alkaline ph unC.S. Biliuribin Result 142 mg/dl

:
Normal reference <200 mg/dl <150 mg/dl 6_8 3_4,5 mg/dl 2,5_3,5 mg/dl <1.00 mg/dl <0,3 mg/dl <115 mg/dl <0,7 mg/dl

220 mg /dl 5,6 g/ dl 2,5 g/dl 3,1 g/dl 0,5 mg/dl 0,2 mg/dl 0,56 u/l 0,3 mg/dl

THYROID TEST :
Test TSH T3 T4 Result 114 /U /ml 0,8 mg/ml 1,8 /U/ml Normal reference 0,4_4,3 0,8_1,6 4,5_11

Medical problems list :

Hypothyroidism . Hypertension . Nephrotic syndrome .

Initial plan :
Admission . thyroxin 100 g . Aldomet (methyl dopa) tabs 250 mg . Aspirin (acetyl salicylic acid) tabs 75 mg . Observe the general condition . Take vitaferrol . BP measuring every 6 hrs.

Daily progress :
Date 18/6/2011 19/6/2011 Subjective C/O : diarrhea C/O : diarrhea objective Pulse : 83 Pulse : 84 BP 150/100 FM +ve FHS ve Pulse : 84 BP 140/90 FM +ve FHS-ve _ Assessment Infection Plan Flagyl drip cefizox Flagyl drip Cefizox

20/6/2011

C/O : non

Date 21/6/2011

Subjective

Objective

Assessment _

plan Antihistami ne agent

C/O :running Pulse :80 nose BP 140/110 FM +ve FHS ve C/O :non Pulse :82 BP 140/100 FM +ve FHS ve Pulse : 83 BP 140/100 FM +ve FHS ve _

22/6/2011

23/6/2011

C/O : non

24/6/2011

C/O : non

Pulse : 80 BP 140/90 FM +ve FHS ve

Drugs list :
drug

indication hypothyroidi sm
Nephrotic syndrome

Dose frequency 100 g/OD

30mg/BID

Start (date) stop 5 years

18/6 18/6

Thyroxin tabs
Prednisolon e tabs Omeprazole tabs

Until discharge
Until discharge Until discharge

Prophylactic 50 mg / OD from peptic ulcer can be made by prednisolone HTN 10mg/OD

Nefidipine tabs Methyldopa tabs furosemide inj

18/6

Until discharge Until discharge Until discharge

HTN

250mg/OD

18/6

odema

40mg

18/6

Drugs list:Drug Aspirin tabs indication Anti coagulant Dose/ frequency 100mg/OD Start / date 18/4 stop 18/4

Vita ferrol caps

Metronidazole infusion Cefozox inj Antihistamine tabs

anemia

100mg/OD

18/4

Until discharge
18/6

diarrhea

100 mg

18/6

infection

1gm/TID

19/6 21/6

21/6 21/6

Runny nose On demand

Drugs related problems:Prednisolone antagonize the hypotensive effect of nefidipine and furosemide . Prednisolone cause peptic ulcer which is prevented by omeprazole . Both nefidipine and prednisolone may cause intrauterine growth restriction and low baby weight. Nefidipine potentiates the effect of methyldopa . HTN may increase risk of clot formation so the pt needs aspirin as anti coagulant . Hyperlipidemia associated with nephrotic syndrome increase the risk of atherosclerosis which can be prevented by antihyperlipidimic agent.

Comments:
the patient had a pre-term labor , NVD The baby is fine and the mother was referred to the renal hospital .

Thanks to all the doctors and medical students that helped us to understand more and improve our knowledge about our work.