CASE PRESENTATION ONURINARY TRACT INFECTION WITH RENAL CALCULI WITH TYPE 2 DIABETES MELLITUS

BYP.SWECHCHA

(611171602016)

PATIENT PROFILE FORM

Name: P.Adilaxmi Age: 35 years Weight: 52 kgs Gender: female Unit: General Medicine IP no: 59581 DOA: 24/1/2014 DOD: 1/2/2014

REASONS FOR ADMISSION

Low backache since 20 years Swelling of lower limbs and face since

20 years

On anti diabetic therapy (tab.apriglim)

Type2 diabetes mellitus since 7 years

PREVIOUS MEDICAL HISTORY

PAST MEDICATION HISTORY

Not relavent

Pallar +

GENERAL EXAMINATION

FAMILY HISTORY

URINARY TRACT INFECTION WITH RENAL CALCULI WITH TYPE 2 DIABETES

MELLITUS

DIAGNOSIS

URINARY TRACT INFECTIONS (UTIS): These are caused by bacteria and are 10

times more common among women than men. It occurs due to Escherichia coli (E. coli), Staphylococcus saprophyticus, diabetes, heavy use of antibiotics.

Symptoms include Blood or pus in the urine, Cramps or pain in the lower abdomen, Chills or fever, nausea, vomiting, Pain during urination etc

RENAL CALCULI (KIDNEY STONES): Changes in the acid-base balance (pH) of

the urine, how concentrated it is, and the concentration of minerals and chemicals within the urine are all factors that can begin the formation of a stone.

  Kidney stones can cause nausea and vomiting, blood in the urine, fever, pain with urination. A severe infection called pyelonephritis can also occur due to blocked urinary flow.

SUBJECTIVE EVIDENCE: Low backache since 20 days Swelling of face and lowerlimbs since

20 daysOBJECTIVE EVIDENCE: Many pus cells in HPF: 1-8 epithelial

cells Ultra sound abdomen report: fatty

liver, right cortical calcification foci, left hydro uretero nephrosias with left renal calculi

PHARMACEUTICAL CARE PLAN

ASSESSMENT: Based on subjective and objective

evidences the patient was diagnosed as urinary tract infection with renal calculi with type 2 diabetes mellitus

To reduce backache To reduce swelling of face & lower

limbs To reduce infection in urinary tract To reduce further complications To normalize blood sugar levels To reduce further symptoms of the

disease

GOALS TO BE ACHIEVED

1. Cephalosporins : Ceftriaxone2. β lactamase inhibitors : Tazobactum Salbactum3. Dihydro reductase inhibitors : Trimethoprim4. Sulfonamide antibiotics: Sulfamethoxazole5. Fluoro quinolones: Ciprofloxacin Ofloxacin

TREATMENT OPTIONS

6. Penicillins : Piperacillin7. Nitro imidazole antibiotics: Metronidazole8. Nitrofurantoin9. Diabetic therapy10.Other therapies: Anti emetics,

Analgesics,Antacids, NSAID’S etc

DRUG CHARTDRUG DOSE RO

AFREQ

1 2 3 4 5 6 7 8 9

Inj. Ciprofloxacin 200mg IV 1-1-1

X X X X

Tab. Apriglim.M2 4mg Oral 1-0-1

Syr. Acitral 1ml Oral 1-1-1

Tab. B-Complex 40mg Oral 1-0-1

X X X

Inj. Pantop 40mg IV 1-0-1

Inj. Zofer 2mg IV 1-0-1

Inj. Tramadol 50mg IV 1-0-1

X X X X X X

Inj. Diclofenac 2ml IM 1-0-1

X X X X

Inj. Piptaz 4.5mg IV 1-0-1

X X X X X

Inj. Metrogyl 250mg IV 1-1-1

X X X X X

Plenty of oral fluids

- - - X X X X X X X X

RBS monitoring - - - X X X X X X X X

Patient : conscious , coherent BP: 110/80 mm Hg PR: 82 beats/min CVS: S1+ S2+ P/A: soft CNS: no FND RS: BAE+ c/o fever with chills, nausea, abdominal

discomfort

DAY-1

Patient : conscious , coherent BP: 112/80 mm Hg PR: 80 beats/min CVS: S1+ S2+ P/A: soft CNS: no FND RS: BAE+ c/o nausea, abdominal discomfort

DAY-2

Patient : conscious , coherent BP: 110/80 mm Hg PR: 78 beats/min CVS: S1+ S2+ P/A: soft CNS: no FND RS: BAE+

DAY-3

Patient : conscious , coherent BP: 110/70 mm Hg PR: 76 beats/min CVS: S1+ S2+ P/A: soft CNS: no FND RS: BAE+ Backache is severe

DAY-4

Patient : conscious , coherent BP: 110/70 mm Hg PR: 82 beats/min CVS: S1+ S2+ P/A: soft CNS: no FND RS: BAE+

DAY-5

Patient : conscious , coherent BP: 110/80 mm Hg PR: 82 beats/min CVS: S1+ S2+ P/A: soft CNS: no FND RS: BAE+

DAY-6

Patient : conscious , coherent BP: 110/80 mm Hg PR: 78 beats/min CVS: S1+ S2+ P/A: soft CNS: no FND RS: BAE+ Swelling of face, lower limbs was

reduced

DAY-7

Patient : conscious , coherent BP: 140/90 mm Hg PR: 86 beats/min CVS: S1+ S2+ P/A: soft CNS: no FND RS: BAE+ Backache is reduced Nausea , abdominal discomfort was

reduced

DAY-8

Patient : conscious , coherent BP: 130/90 mm Hg PR: 86 beats/min CVS: S1+ S2+ P/A: soft CNS: no FND RS: BAE+ Patient is dicharged

DAY-9

Swelling of face & lower limbs was reduced by day 7

Nausea , abdominal discomfort was reduced by day 8

Back ache is reduced by day 8

GOALS ACHIEVED

RBS monitoring as the patient is having type2 diabetes mellitus since 7 years

Ultra sound scan for abdomen Urinary analysis

MONITORING PARAMETERS

BLOOD TESTS: RBS: 100mg/dL Serum creatinine: 0.9 mg/dL Blood urea: 36 mg/dL Hb: 9gm% TC: 7300 cells ESR: 30 mm/hr M/S: many pus cells 1-8 epithelial cells -

HPFULTRA SOUND SCAN ABDOMEN: Liver: increased echo texture

LAB INVESTIGATIONS

Gall bladder: contracted Kidney: e/o 6.7x6.3mm hyper echoic texture is

noted e/o mild dilation of left PCT & ureter is

noted e/o 3 hyper echoic foci of 3mm is noted e/o decreased echo texture or medial

surface of cortex is noted Conclusion: Rt cortical calcification

focus,Lt hydro uretero nephrosis with renal calculi & doubt of focal pyelo nephritis

Ciprofloxacin + Metronidazole - nausea , vomitings generally

Ciprofloxacin + Aluminum hydroxide - decreases levels of Ciprofloxacin

Ciprofloxacin + Ondansetran – ECG changes

Diclofenac + Glimepiride – increases effects of glimepiride

Ciprofloxacin + Glimepiride - increases effects of glimepiride

Metronidazole + Diclofenac - increases effects of diclofenac

PROBLEMS IDENTIFIED

ABOUT DISEASE: Patient is acknowledged about the

signs & symptoms of the disease like fever with chills, nausea, vomiting, pain in the lower abdomen region, pain during urination.

ABOUT DRUGS: Inj. Ciprofloxacin: It is advised to take

200mg IV thrice a day (flouroquinolone antibiotics). It is a specific antibiotic used for UTI’s.

PATIENT CONSELLING

Inj. Piptaz : It contains Piperacillin +

Tazobactum which are advised to take 4.5gm IV twice a day. (penicillin's, β lactamase inhibitors)

Syr. Acitral: It is advised to take 2 teaspoons full(1ml) diluted in 75ml orally thrice a day. It contains Aluminium hydroxide ,Magnesium hydroxide, Simethicone (antacid). As the patient is having abdominal discomfort .

Inj. Pantop: It contains pantoprazole (proton pump inhibitor). It is advised to take 40mg IV once a day.

Tab. B complex: It is advised to take 40mg orally once a day (vitamin supplement).

Tab. Apriglim.M2: It contains Glimepiride

(anti diabetic drug).It is advised to take 4mg twice a day after the intake of food.

Inj. Zofer: It contains ondansetron (anti emetic). It is advised to take 2mg IV twice a day.

Inj. Tramadol: It is advised to take 50mg IM twice a day.(opioid analgesic-SNRI).It is used to treat severe pain.

Inj. Diclofenac : It is advised to take 2cc (2ml) IM twice a day(NSAID). It is used to reduce pain.

Inj. Metrogyl: It is advised to take 100ml IV

thrice a day. It contains Metronidazole (Nitro imidazoles-antibiotics)

ABOUT DIET: Drink a lot of fluids, such as herbal teas

and water. Avoid sweetened fruit juices and other sweetened drinks.

Avoid coffee and other stimulants, alcohol, and tobacco.

Eat more high fiber foods, including beans, oats, root vegetables (such as potatoes ).

More water should be taken. Calcium and salt restriction.