Caringal, Elyssa Claris C.

Case 1
Castillo, Kayzelle Anne S. April 27, 2017
Cruz, Helen Faith P.

Pharma 2-1

I. Subjective

Sign Symptom

Abdominal Pain Anorexia

Diarrhea Hypertension

Tenesmus
Table 1.1 Sign and Symptoms
II. Objective

Normal Range
Hemoglobin 11.7 g/dL 11.5-16.5
White Blood Cell Count 21.5x109/L 4-11
Platelet Count 170x109/L 150-400
Serum Sodium 133 mmol/L 137-144
Serum Potassium 3.2 mmol/L 3.5-4.9
Serum Urea 8.2 mmol/L 2.5-7.5
Serum Albumin 38 g/L 37-49

Table 1.2 Clinical Lab Results

Abbreviations
BP Blood Pressure
ICU Intensive Care Unit

Interpretations
In this case the patient is a 68-year-old woman that has a lab result showing a high White
Blood Cell Count and Serum Urea, and a low Serum Sodium and Serum Potassium. Her
 body temperature is 37.5C, a pulse rate of 65 beats per minute, and a blood pressure of
115/70 mmHg.

III. Assessment

Blood in stools is more likely with some infections, Shingella and Escherichia coli
01557: H7, than with others, e.g. viral gastroenteritis or Salmonella. Since the ondet was 2 weeks
after the return from Cambodia and Vietnam, this makes shingellosis unlikely. Shingellosis also
known as bacillus dysentery, an invasive disease of the human colon, is present worldwide.
Shingellosis is characterized by fever, abdominal cramps, tenesmis, and dysenteric stools
containing mucus, blood, and pus. These systems reflect invasion of colonic mucosa by
Shingella, the critical stage in the pathogeneic process. Shigellosis is spread by means of fecal-
oral transmission. Other modes of transmission include ingestion of contaminated food or water
(untreated wading pools, interactive water fountain), contact with a contaminated inanimate
object, and certain mode of sexual contact. Vectors like the housefly can spread the disease by
physically transporting infected feces.
On the other hand, pathogenic salmonellosis ingested food survive passage through the
gastric acid barrier and invade the mucosa of the small and large intestine and produce toxins.
Invasion of epithelial cells stimulates the release of pro inflammatory cytokines which induce
inflammation reaction. The acute inflammatory and destruction of the mucosa. The bacteria can
disseminate from the intestines to cause systemic disease. S. typhimurium and S. enteritidis
produce gastroenteritis.
Another possible condition was Pseudombranous colitis or Clostridium difficle-
associated diarrhea. It is not possible to differentiate Pseudomembranous colitis from other
causes of Colitis on clinical criteria alone. However, due to lack of recent antibiotic treatment
would go very much against Pseudomembranous colitis in this case. The most common bacterial
cause of bloody diarrhea in Cambodia and Vietnam was Escherichia coli 0157:H7. This bacteria
was acquired by eating contaminated food and water. This can also be acquired by direct contact
with infected person. Systemic infections caused by E. coli are frequently seen in neonates either
by means of vertical or horizontal transmission. The characteristic serotype of this pathogenic E.
coli displays the K1 antigen, which is responsible for 40% of the cases of bacteremia and 80% of
the cases of meningitis caused by E coli. The virulent activity of the K1 antigen reduces the
ability of the host to develop an antibody specific response and to activate the alternative
complement system. In addition, S. fimbriae have been associated with many of the E. coli of
patients with CNS infections. S. fimbriae enhance the ability of E. coli to adhere to vascular
epithelium as well as the spread of the bacterium within the CNS.

IV. Plan

Pharmacological treatment
Avoid taking an anti-diarrheal medication this slows a patient digestive system down,
preventing your body from getting rid of the toxins.
Antibiotics generally aren't recommended because they can increase the risk of serious
complications.
Blood Transfusion
Kidney dialysis
Avoid these nonprescription products if you have or suspect you have an E. coli infection
Loperamide products. These include Imodium, Maalox, and other antidiarrheal products.
Products containing salicylates. These include Pepto-Bismol and similar bismuth-based
antidiarrheal products, aspirin, and ibuprofen (such as Advil). Salicylates can increase
bleeding from the intestines. Also, salicylates are associated with Reye syndrome, a rare
but serious illness in children.

Non Pharmacological Treatment:

Rest

References:
Chatterjee, A. (2015). Pediatric Escherichia Coli Infections. Retrieved on April 26,2017 from
http://emedicine.medscape.com/article/970451-overview#a/

Giannella RA. Salmonella. In: Baron S, editor. Medical Microbiology. 4th edition. Galveston
 (TX): University of Texas Medical Branch at Galveston; 1996. Chapter 21.
Owens, M. (2017. Salmonella Infection: Emergency Medication. Retrieved on April 26,2017
from http://emedicine.medscape.com/article/785774-overview#a4
Sureshbabu, J. ( 2016). Shingella Infection. Retrieved on April 26,2017 from
http://emedicine.medscape.com/article/968773-overview#a4
WebMD. (n.d). E.Coli Infection from Food and Water- Treatment Overview. Retrieved on April
26, 2017 from http://www.webmd.com/a-to-z-guides/tc/e-coli-infection-treatment-
overview
Wiley, J. & Sons. (2010). Infectious Disease. Retrieved on April 26,2017 from
https://books.google.com.ph/books?id=U2BuAwAAQBAJ&dq=Case+about+abdomen+
was+diffusely+tender+but+not+distended,+blood+in+her+stools&source=gbs_navlinks_