Clinical Pharmacy Lab

Presentation
PD-614
Case Study
A 67 year old female was admitted in the Emergency room
with complain of vomiting and Loose stools since the past 4
days and provisionally diagnosed with Acute Gastroenteritis.
She has a serious electrolyte imbalance treated with N/S
1000ml and Inj Gravinate (Dimenhydrinate) and shifted to the
Female medicine ward for further treatment.
 Disease History:
Diabetes Mellitus II and Hypertension

Medication Medication History:

History Glucophage and Anti-hypertension medications (not mentioned)

 Hematology Normal values RESULT
(17-SEP-2023)
Hemoglobin 12-15 8.2 gm/dl
RBCs 3.9-4.8 2.3x10/L
Neutrophils 33-35 71%
INR 10-13 sec 22.6 se10-13 sec

Laboratory UCE Normal Values Results

Findings (17-sep-2023)
(Abnormal Values) Potassium 3.5-5.1 2.8mEq/L
Sodium 136-146 150mEq/L
Magnesium 1.7-2.2 2.41mmol/L
Chloride 98-107 120mmol/L
Bicarbonate 23-29 13.7mmol/L
 Sample: Urine C/S
Microorganism: Growth of Candida and Ecoli
Sensitive to (Antibiotic): Linezolid, tetracycline, Amikacin,
Ceftazidine, fosfomycin, Gentamycin, Nitrofuran
Resistance (Antibiotic) to: Piperacillin, Tobramycin, Monocyclin,
Meropenem, Co-trimoxazole, Cipro, Cefuroxime, Cefixime,
Culture Ampicillin, Amoxicillin, clindamycin, erythromycin
Sensitivity Test
Urine Examination: Numerous pus cells, RBCs, with protein (+ ve)
Medication Dose Route Frequency
Inj Dimenhydrinate 50mg IV SOS
Inj ciprofloxacin 400mg IV BD
Inj metronidazole 500mg IV BD
Inj Insulin R -- IV --
Inj KCL Amp ( dil in 0.9 % -- IV --
NaCl @ 40cc)
Inj MgSO4 2g IV STAT
Tab Amlodipine Besylate 10mg ORAL OD

Inj hydralazine (dil in 10 cc 20mg IV STAT

N/S)
Inj Omeprazole 40mg IV OD
Glycerine suppository -- Rectal 4xSTAT
Inj Ondasterone -- IV TDS
Inj Risek 40mg IV OD
 1) Ciprofloxacin + Ondasterone
Type : serious
Ciprofloxacin and ondasterone both increase QTC interval
2) Ciprofloxacin + Insulin R
Type : Monitor closely
Cipro increase effect of Insulin R by pharmacodynamics synergism.
Dose Hyper or hypoglycemia is reported in patient
3) Omerprazole + Ciprofloxacin:
Interaction Type : monitor closely
Omeprazole will decreae level of ciprofloxacin by unknown
mechanism
4) KCL + Insulin R:
Type : minor
KCL increase effects of Insulin R by pharmacodynamics synergism
 • Avoid or use alternate drugs for serious interacted
medicines. Avoid with congenital long QTC syndrome. ECG
monitoring recommended with concomitant medications
that prolong QTC interval, electrolyte imbalance CHF or
Bradyarrthymia.

Pharmacist • Use with caution and monitor adverse effect reported

Recommendation • Minor/Significance unknown interaction specially seen in
OR Interventions treatment of hypoglycemia

• Ciprofloxacin is resistance in Urine culture report and

cannot be use in the treatment of UTIs (in case) but it can be
use in the treatment of other infectious disease like
Gastroenteritis.
 Sarah Khan
Areebah shahid
GROUP Ayesha Mashkoor
MEMBERS: Labiqa ayaz
Faria pervaiz
Neha
Rubab