Case presentation

By
K.Harshith
615175802011
VI /VI Pharm.D
 A 25 year male patient was admitted into hospital

COMPLAINTS
• Epigastric pain with 4 episodes of vomiting since 2 days
• Fever
• Constipation

ON EXAMINATION
• conscious,oriented,febrile
• P/A - soft,non tender
• BP - 120/80 mmHg
• TEMP - 103°
• PR - 79
• PAST MEDICAL HISTORY - NIL
• PREVIOUS ALLERGY - NIL
• FAMILY HISTORY - NOT AVAILABLE
• OCCUPATION - DRIVER
• SOCIAL HISTORY
H/O
Alcohol intake 180ml /day since 5yrs
Tobacco 10 cigarette/day
 DAY WISE VITALS

D-1 D-2 D-3

BP {mmHg} 120/80 120/80 120/80

PR{BPM} 79 90 90
RR {CPM} 24 22 20

TEMP{°C} 103 100 98.6

 Laboratory Investigations

PARAMETER NORMAL RANGE RESULT

CREATININE 0.6-1.2 mg/dl 0.9
SODIUM 135-145 mmol/l 139
POTASSIUM 3.5-5.5 mmol/l 3.8
HEMOGLOBIN 13-17 g% 16
WBC 4000-11000 cells/mm³ 12600
RBS <140 mg/dl 118
PARAMETER NORMAL VALUE OBSERVED VALUE
TOTAL BILIRUBIN Upto 1.0 mg/dl 3.66
DIRECT BILIRUBIN Upto 0.3 mg/dl 2.63
INDIRECT BILIRUBIN Upto 0.7 mg/dl 1.03
SGOT Upto 42IU/L 256
SGPT Upto 40IU/L 201
ALP 32-130 IU/L 242
 OTHERS

ECHO:-
• normal valves & chambers
• no rwma
• good lv & rv function
Abdominal ultrasonography:-
• Hepatomegaly with fatty infiltration

DIAGNOSIS:
• ALCOHOLIC HEPATITIS
 REGIMEN

•  Patients with AH should be considered for nutritional supplementation and treat

alcohol withdrawal symptoms.
• Patients with severe AH should be treated with corticosteroids if there are no
contraindications for their use.
• In severe case liver transplantation.
PATIENT SPECIFIC GOALS
• To improve the quality of life
• To improve LFT’S
• To prevent the progression of cirrhosis.
 DRUG CHART
MEDICATION GENERIC NAME DOSE FREQ ROUT D-1 D-2 D-3
E
T.LIBRIUM CHLORDIAZEPEROXID 25mg BD P/O 
E
I.PAN PANTOPRAZOLE 40mg OD IV   

T.UDILIV URSODEOXYCHOLIC 300mg BD P/O   

ACID
S.LACTULOSE LACTULOSE 15ml H/S P/O  

I.MONOCEF CEFTRIAXONE 1gm BD IV   

T.OXAZEPAM OXAZEPAM 15mg BD P/O   

I.TRAMADOL TRAMADOL 50mg SOS IV   

INJ.PCM PARACETAMOL 1g BD IV 

T.DOLO ACETAMINAPHEN 650mg SOS P/O  

MVI with DNS MULTIVITAMIN, 75ml/hr  

DEXTROSE NORMAL
SALINE
 Day Notes

• Day 1:
• BP is normal 120/80mmhg
• Temp :103
• Day 2:
• BP and PR is normal
• Temp: 100
• Day 3:
• BP and PR is normal
• Patient is in stable condition.
PHARMACIST INTERVENTIONS:
OXAZEPAM – TRAMADOL
• concurrent use may increase risk of respiratory and cns depression
 DISCHARGE MEDICATIONS

• T.PAN 40mg OD
• T.OXAZEPAM 15mg HS
• S.DUPHALAC 10ml HS
• T.UDILIV 300mg BD
 NON PHARMACOLOGICAL PLAN

• Oxazepam may causes dizziness so the patient should avoid activities requiring
mental alertness
• While taking oxazepam patient should avoid drinking alcohol
• Pantoprazole should be taken atleast 30 min before breakfast
• Auit alcohol
• Avoid smoking
• Avoid foods high in fats,sugar and salt
• Eat fiber rich foods such as fruits,vegetables,whole grans etc
• Drink plenty of water
• Eating citrus fruits may reduce liver damage
• Take high protein diet such as meat,eggs,milk,beans,nuts
 Reference

• Micromedex
• Medscape
• American gastroenterology association.
THANK YOU