Case Presentation

Viral Hepatitis

K.Pruthvi Kumar Reddy

II Pharm D

Patient Profile
Name : xxxxx
Age : 27 years
Gender : male
Unit : Male Medical Ward
Date of admission : 28/9/2010]
Date of discharge : 05/10/2010

Chief complaints :
On 29/09/2010
Blackish pigmentation all over the
body, burning micturition.
on 30/09/2010
Swelling of lower limbs
on 01/10/2010
Fever, myalgia, pallor
on 03/10/2010
Fever
on 04/10/2010
Fever with vomitings

On examination :
28/09/2010
Temperature : 1020 F
BP :
110/80
Pulse :
86/mt
29/09/2010

BP : 110/60
Pulse :

84/mt
Urine
output : 800ml

On 01/1o/10

BP : 110/70 mm hg
Pulse : 86/mt
Total IV fluids : 1o00 ml
Total oral fluids : 500

ml
Total urine output :
1850 ml
On 02/10/10
Pulse : 84/mt

BP : 130/70 mm hg
Total IV fluids : 1000

ml
Total oral fluids : 500
ml
Total urine out put :
2,600 ml

On 04/10/10
84/mt

BP : 120/70 mm hg Pulse :
Total IV fluids : 1000
Total oral fluids : 500 ml
Total urine output : 2,900 ml

On 05/10/10

BP : 100/60 Pulse : 82/mt

Total IV fluids : 500 ml
Total oral fluids : 600 ml
Total urine output : 2,500 ml

On
28/0/2010
SPECIMEN PARAMETE
R

OBSERVED
VALUE

Blood

Hb

9.5 g/dl

Blood

PCV

23.8%

Blood

TC

21,200

Blood

NORMAL
VALUE
11-16.5
g/dl
35-50%
3,50010,000

22.2%

15-30%

5.35%

2-10 %

72.5 %

40-70 %

Lymphocyt
e
Blood

Mid cells

Blood
Neutrophils
Blood

ESR

104mm/hr

0-20
mm/hr

Blood

Platelets

75,000

1-4 lac
cells

SPECIME
N

PARAMETER

OBSERVED
VALUE

NORMAL
VALUE

Blood

Creatinine

1.1 mg/dl

0.8-0.9 mg/dl

Blood

SGOT

352 U/l

6-38 U/l

Blood

SGPT

160U/l

6-38U/l

Blood

ALP

200 Mu/L

36-142mu/ml

Blood

T.Bilirubin

26.4 mg/dl

0.5-1.1mg/dl

Blood

D.Bilirubin

14 mg/dl

<0.4mg/dl

Serum

Sodium

122.9mmol/
l

135-148mmol/l

Serum

potassium

3.8 mmol/l

3.5-5.3 mmol/l

Serum

chlorides

96.7 mmol/l

98-107 mmol/l

On 29/09/2010
SPECIMEN PARAMET
ER

OBSERVE
D VALUE

NORMAL
VALUE

Blood

Platelets

1,17,000

1-4 lac
cells

Blood

PT

11.8 sec

13-17 sec

Blood

APTT

33.5 sec

27-36 sec

Urine

Pus cells

3-4

Urine

Epithelial
ells

1-2

Blood

INR

1.0

0 cells
0 cells

SPECIME
N
Blood

PARAMETE NORMAL
R
VALUE
Albumin

Blood

T.Protiens

Blood

SGOT

Blood

SGPT

3.5-5 g/dl
6.8-8.3
g/dl
6-38 U/l
6-38 U/l

OBSERVED
VALUE
1.7 g/dl
4.6 g/dl
122 U/l
117 U/l

Blood

ALP

36142mu/ml

152 Mu/l

Blood

D.Bilirubin

<0.4mg/dl

20 mg/dl

Blood

I.Bilirubin

Blood

PT

Blood

APTT

Blood

INR

<0.6mg/dl
1 13 17
sec
27-36sec
1.o

11.6 mg/dl
11 sec
26.5 sec

On 04/10/2010
SPECIME
N

PARAMETER

OBSERVED
VALUE

NORMAL
VALUE

Blood

Albumin

2 g/dl

Blood

T.Protiens

5. 6 g/dl

6.8-8.3g/dl

Blood

SGOT

44 U/l

6-38 U/l

Blood

SGPT

60 U/l

6-38 U/l

Blood

ALP

140

36-142
mu/ml

Blood

T.Bilirubin

Blood

D.Bilirubin

8 mg/dl
4 mg/dl

3.5 -5 g/dl

0.5-1.1
mg/dl
<0.4

Diagnosis : Hepatitis
Hepatitis B infection is diagnosed with blood
tests. These tests can detect pieces of the
virus in the blood (antigens), antibodies
against the virus, and viral DNA ('viral load').
Blood tests for HBV are often done when
routine blood work shows
abnormal liver function tests or in patients
who are at an increased risk for exposure. If a
patient has had a large amount of vomiting or
has not been able to take in liquids,
blood electrolytes may also be checked to
ensure that the patient's blood chemistry is in
balance.
Definition : Hepatitis is a viral disease caused
by hepatotropic virus. It is mainly transmitted

BRAND NAME

GENERIC
NAME

DOSE

T.Udiliv

Urso deoxy
cholic acid

150 mg

Oral BID

28/09-05/10

T.Hepamerz

L-Ornithine
L-Aspartate

150 mg

Oral

BID

28/0905/10

S.Lactulose

Lactulose

---------

BID

28/0905/10

Inj.Lsix

Furosimide

200
mg

IV

Inj.cefuroxime

Cefuroxime

1g

IV

Inj.Rantac

Rantidine

50 mg

ROA F

Oral

BID

REGIMEN

28/0905/10

BID 29/09-05/10

IV

29/09-05/10
BID

Inj. Vitamin k

-----------------

---------- -

IM

1da
y

29/09-01/10

BRAND NAME

GENERIC
NAME

DOSE

Inj.Falcigo

Artesunate

60
mg

T.PCM

Paracetmol

500
mg

T.Azithral

RO
A
IV

F
OD

01/0-04/10

TID

01/1005/10

BID

03/1004/10

Oral

Azithromycin
500mg Oral

T.Cetrizine

Cetrizine
hydrochloride

10 mg

BID
Oral

REGIMEN

03/1005/10

SOAP NOTES :
Subjective : Blackish pigmentation all over
the body
Swelling of lower limbs
Objective : ESR : 104 mm/hr Hb : 9.5 g/dl
Platelets : 75,000 Total proteins :
4.2g/dl
Bl.Urea : 68 g/dl
SGOT : 352 U/l
SGPT :160U/l
ALP : 200mu/l
Albumin : 1.9 Total bilirubin : 26.4
mg/dl
Pus cells : 3-4 PCV : 35-50%

Plan :

Identify and treat to remove the precipitating

cause.
Reduce or eliminate the protein intake and provide
oral or
IV carbohydrate to serve as alternate
source of
energy.
Provide lactulose (10-30ml-3times a day) or lacitol
(30g per day) which limits the absorption of NH3
and acts as a laxative to empty the bowels of
nitrogenous substances.
Neomycin (1g/6 hr) may be given as it reduces the
quantity of intestinal bacteria.
Electrolyte balances are corrected if any.

FARM NOTES :
Findings :
1.Azitromycin + Food
2.Loop diuretics + H2 Blockers
3.Loop diuretics + Food
4.Alcohol + H2 Blockers
Assessment :
1.Food halves the absorption of Azithromycin
from the capsule form.
2.Rantidine increases the bio availability of
Furosimide.
3.Food moderately decreases the bio
availability and diuretic effects of Furosimide.
4.Blood alcohol levels are raised when taken

Resolution :
1.Azithromycin should be administered
before taking food.
2. As the clinical importance is nill with
this combination no speecial
precautions are taken unless in the
conditions of severe diuresis.
3.Furosimide should be administered
before taking food.
4.Alcohol and H2 blockers are not to be
taken together and it is better to avoid
alcohol.

Patient counseling :
1. I will advice the patient not to take
alcohol as it worsens the liver
functioning.
2. I will advice the patient not to take or
minimise the protein intake.
3. I will educate the patient not to
smoke as it still causes the deficiency
of a1Antitrypsin and causes
emphysema.