CASE STUDY ON MAKBUL HUSSAIN CHOWDHURY Pharm. D 4'* YearUil -AN OVERVIEW + UTIs are common, especially among women * UTIs in men are less common and primarily occur after 50 years of age * UTIs infection usually occur by ascending route (urethra to bladder) * UTIs infection is less common by haematogenous spread (kidney) * UTIs occur in two general settings: community- acquired and hospital acquired.“Urethritis — Infection of anterior urethral tract Mevagoes dysuria, urgency and frequency of micturition = Dysuria ;(burning pain on Passing aang} - Urgency ;(the urgent need to pas urine - Frequency of micturition Kon “Cystitis — Infection of urinary bladder dysuria, frequency, pyuria and haematuria Bacteriuria. Presence of bacteria in urine Uta Account of 100 organisms/ml or more in urine * Pyuria - Presence of pus in urine (more than 10 cells/HPF) Pyelonephritis: Infection of kidney ; flank pain, [ \ an bacco pyuria, fever, chills, nausea tClinical Features Acute lower UTIs (Urithritis and cystitis): Rapid onset of: ~ Dysuria (burning pain on Passing urine) (the urgent need to Pas urine) - Frequency of micturition Upper UTIs (Pyelonephritis): - Fever - Chills - Dysuria - Urgency - Frequency of micturition Etiology Of Urinary Tract Infections Causative organisms: 1- Bacterial 2- Viral 3- Fungal 4- ProtozoalOTRER RISK FACTORS; - Sex . Anatomy and Physiology of woman’s organ. . Urinary Catheters. . In Children’s; Due to Vesicoureteral reflux. . Hyperplasia: causes obstruction of the uretra. . Diabetes.SOAP STUDYPatient Details... CRNo. — : 8621/13 Age :30y :M 2 29/11/17 04/12/17 (No. of days in hospital = 05 )Cnier Compilaints/rresenting symptoms... ® Fever with high grade chills @Headache & body-ache (since last 07 days). ® Loose stools ~] (since last 02 days). ® Vomiting (2-3 episodes) —Past History & Food Nabits... ® No history of DM or TB or HTN. ® Family history: Not significant. ® Social history : No history of addiction. © Vegetarian. ® Non-smoker.Vitali Cnart (As On 30/71/17) ® BP 130/90 mmHg ® Temp. = 100.2°F ® RR 24/min ® PR 108/minLaboratory Vata (aS ON 35U/ 12/13) LAB. TEST eau aS Total Bilirubin Serum Potassium Serum Sodium Serum SGOT Serum SGPT iia t ees | 0.8 mg/dl 3.8 mmol/L 135mmol/L 44 1U/L 59 IU/L. 13 mg/dl NORMAL VALUES 0.2-1.3 (Adults) 1.0-10.5(Neonates) 3.5-5.1 mmol/L 137-145 mmol/L 14-36 IU/L (F) 17-59 TU/L(M) 9-52 IU/L (F) 21-72 IU/L (M) 7-17 mg/dl (F) 9-20 mg/dl (M)Laporatory Vata (AS On 31/03/17) Oar cocoa Coe Normal Values Hb.(g/dl) 13.6 11.5-16.5 TLC (/cumm.) 5300 4000-11000 Neutrophils (%) 65 40-75 Lymphocytes (%) 32 20-45 Eosinophils (%) 00 01-06 Monocytes (%) 02 02-10 Basophils (%) 00 0-2 RBC(million/cumm.) 4.41 3.8-4.8 Platelet(lacs/cumm.) 1.5 1.5-4.0 MCV 90.2 0-20Diagnostic tests; ® On 30-11-2017 Test for (MP antigen) : negative @ Widal = negative » Urine Microscopic examination- 30-11-17 Pus cells- 6-10cells/hpf (occasional clumf) Epithelial cells- 2-3/hpfASSESSMENT & TREATMENT PLAN....Diagnosis... + Based on the reports of routine urine examination and microscopy, the present case was diagnosed as that of Urinary tract infection on 31/05/13.inerapeutic Goails.. ® To lower the body temp. ® To provide the relief from headache and body-ache ® Prevention of vomiting. ®To eradicate the infection of Urinary tract and to prevent the chances of relapse.DE ara WAU) symptoms withdrawn Fever with high grade chills, and loose stools. (PR= 76/min, RR= 22/min, WCE emcee Inj. Mole (stat) (paracetamol) Inj.Palin 40mg, IV,BD(pantaprazole) Inj.Geminate plus 1.5gm, TDS, IV, (ceftriaxone) Syp. Rqual, 2tsf, TDS (multivitamins)} Dynes Medication | Medication added | symptoms withdrawn Adv. — Routine urine examination and microscopy. Rx, tab. Lanna? 2 tb stat tb 1 after 6 hr.Day & Symptoms “DAY 03 (02.11.17) At Spm Temp.99.6F DAY 04 (02.06.13) (BP=110/80mmHg PR=76/min, RR=22/min Temp=98F) GC stable, | Medication Mee kaa WCE Caer Tb. Calpol given tb. Norflox, 400mg , BD (norfloxacin) syp. Alkasol, 2tsf, TDS (disodium citrate) tb. Sibelium, 10mg, HS flunarizineWCET CeCe Cee Cae SUL haa | Day & symptoms DAY 05 (3.12.17) CST (BP=130/80mmHg PR=72/min, RR=22/min Temp=98F) GC stable, No fresh complaint DEN ATAU TOAD) Patient discharged (BP=120/70mmHg a PR=80/min, RR=20/min eed Temp=98.6F) GC stable, No fresh complaintDAY OF DISCHARGE (4.12.17) — Condition of the patien improved and prescription revised for discharge. Discharge summary is as follows: 1. Tab. Pantocid 400mg BD 2. Tab. Norflox 400mg BD 3. Syp. Alkasol 2tsf TDS 4. Syp. Rqual 2tsf TDS All medications for 5 days. Advice to repeat Routine Urine Examination & Microscopy tests and follow up after 5 days.Clinical Justification The treatment given to the patient was almost satisfactory and the condition of patient was improved at the time of discharge but apart from this there are some instead that are: »Tab. Lariago was given irrationally because if there was a negative test report of malarial parasite then why that particular drug was prescribed.nererences... © Patient case record. ® Dipiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM. Pharmacotherapy:A Pathophysiologic Approach. 6 ed. New York: The McGraw-Hill Companies; 2005. ®www.elsevierimages.com accessed on 02.06.13