CASE PRESENTATION ON

ACTUE GANGRENOUS
CALCULOS CHOLECYSTITIS
Presented by :
K.CHANDANA(20GN1T0008)
Pharm. D 2nd year
Avanthi institution of pharmaceutical
sciences Gunthapally R.R Dist
Patient demographic details
• Name: XYZ
• Age: 55yrs
• Gender: female
• Ipno: 66480
• Weight:64 kgs
• Height:160cm
• Department : Gastro enterology
• DOA : 25/04/22
• DOD : 29/04/22
Pharmaceutical care plan (soap analysis)

• SUBJECTIVE EVIDENCE :
• Chief complaints : Abdominal pain , Vomitings

• Past medical history :

Diabetics(DM),Hyperthyroidism
• Past medication history : Tab-GluminyleMv2 Forte
• Social history : Nil
OBJECTIVE EVIDENCE
ON EXAMINATION

 PATIENT : Conscious

 BLOOD PRESSURE : 120/80 mm/Hg

 PULSE RATE : 88bpm

 Severe Tenderness at Right Hypochondrium and mid distension

LAB INVESTIGATIONS

INVESTIGATIONS NORMAL VALUES DAY-1 DAY-2

HAEMOGLOBIN 12-16% 14.4 11.4

PLATELET COUNT 1.5 – 4 lakhs 5.28 8.73

cells/cumm

PCV 36-46% 44.5 35.9

LIVER FUNCTION TESTS
INVESTIGATIONS NORMAL VALUES DAY-1

Total Bilirubin 0.2-1mg/dl 0.6

Direct Bilirubin 0.02mg/dl 0.4

Total protein 6.4-8.2g/dl 8.3

SGPT(ALT) 5-48u/L 25

SGOT(AST) 5-45u/l 34

Albumin 3.4-5g/dl 5.1

Globulin 2.3-3.6g/dl

ALK Phosphotase 138

ELECTROLYTES
INVESTIGATIONS NORMAL VALUES DAY-1 DAY-2

Sodium 135-145 meq/l 137 140

Potassium 3.5-5.2 meq/l 3.9 3.7

RENAL FUNCTION TESTS
INVESTIGATIONS NORMAL VALUES DAY-1 DAY-2

Urea 15-40mg/dl 18 26
Serum creatinine 0.6-1.3mg/dl 0.6 0.6
• OTHER INVESTIGATIONS UGI :-

cholecystectomy

• FINAL DIAGNOSIS :-

Actue Gangrenous Calculos Cholecystitis

 Drug chart
S.No DRUG NAME GENERIC NAME CATEGORY DOSE FREQUENCY ROA DAYS OF
TREATMENT

1 Inj.MAGNEFORT CEFOPERAZONE ANTIBIOTIC 1.5mg BID IV 2

E
2 Inj.PAN PANTAPARAZOLE PPI 40mg BID IV 4

3 Inj.PARACETAM ACETAMINOPHEN ANTIPYRETIC 1mg TID IV 4

OL
4 Inj.ZOFER ONDASETRON ANTIEMITIC 1mg BID IV 2

5 Tab.THYRONOR LEVOTHYROXINE SYNTHETIC 100mg OD P/O 3

M THYRIOD
HORMONE
6 Inj.PIPTAZ PIPERACILLIN ANTIBIOTIC 4.5mg BID IV 2
Discharge Medications
1. TAB.MONOCEF-CV1TAB-PO-VID

2. TAB.DALACIN -300mg – PO-BID

3. TAB.DOLO – 650mg –PO –TID

4. TAB.PANTOCID– 1cap – BID

5. TAB.JALRA-M – 50/800 - PO—BID

6. INJ.HUMAN MIXTARD – 30/90 – subcutaneous-20u-morning &10u-Night

 Pharmaceutical care plan
 Subjective evidence:-
A 55 years old female patient came to hospital with c/o serve right upper abdominal pain
for 3 days associated with vomiting.

 Assessment:-
From subjective and objective evidence patient is diagnosed with Acute Gangrenous Calculous Cholecystits.

• Definition:

Necrosis and perforation of the gall bladder wall as a result of ischemia following progressive vascular
insufficiency
• THERAPEUTIC GOALS:-
To maintain bowel rest
To correct the Electrolyte abnormalities
To cause Symptomatic relief
To minimize disease progression
• ASSESSMENT OF CURRENT THERAPY:-
MANGER FORTE – Used to treat various bacterial infection
PAN – To treat acid related disease of stomach
PARACETAMOL – To relief pain caused by headache
ZOFER – To control nausea & vomiting due to stomach upset
THYRONRM – To treat underactive/hypothyroidism
PIPTAZ – To treat bacterial infections
MONOCEF – To treat bacterial infections
PANTOCID – To treat acid related disease of stomach
JARLA – To treat type diabetics mellitus
DALACIN – To treat infection caused by bacteria
DOLO – To treat nerve pain
Monitoring parameters

• THERAPEUTIC PARAMETERS :-
Regular monitoring of Vitals
To reduce the symptoms
Check up on lab tests
• TOXICITY PARAMETRES :-
1.MAGNEX FORTE– Diarrohea, anaemia, allergic reaction.
2. PAN –Diarrohea, headache, joint pain, nausea
3. PARACETAMOL –Nausea, constipation,nausea
4. ZOFER –Constipation, diarrohea, fatigue
5. THYRONORM –Anxiety, diarrohea, weight loss
6. PIPTAZ – Fever, stomach pain, constipation
DRUG INTERACTIONS:-
1. LEVOTHYROXINE < > PANTOPRAZOLE > Reduces the effectiveness of levothyroxine.
2. CEFPOCLOXINE < >PANTOPRAZOLE> Reduces absorption /blood levels of Cefpodoxime.
FOOD DRUG INTERACTIONS:-
1. Administration /using multivitamin with minerals together with levothyroxine decrease the effect of levothyroxine.
2. Metform (Jarla)< > Alcohol which causes a build up of lactic acid.
PHARMACIST INTERVENTION:-
Minor drug interactions were found. But did not effect the patient.
By dose , frequency adjustments should be done by clinical pharmacist.
Cefprodoxime and Pantoprazole together should not recommend , so need to stop.
PATIENT COUNSELLING:-
1. Low sodium content should be taken.
2. Avoid weight lifting, forwarding bending.
3. Low fat content food.and avoid strenuous activity
4. Proper diet should be maintained.
REPORT:-
The given case is studied and analyzed . The given drugs or appropriate. The dose and
frequency of administration is appropriate.