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Similar to Known case of type 2 Diabetes Mellitus with hypertension with urosepsis
Known case of type 2 Diabetes Mellitus with hypertension with urosepsis
- 1. CASE PRESENTATION ONK/C/O T2DM, HYPERTENSION WITH UROSEPSIS Presented by: S.SHAIK IMRAN HUSSAIN
- 2. DEMOGRAPHIC DETAILS: • PatientName:XXXX • Age:56yrs • Sex:Female • Ward:Female ward-01 • IP No:9267 • DOA:20/2/2021 • DOD:01/3/2021 • Physician:Dr.Maheshwara, M. D
- 3. History of presentillness: • Fever • Burning micturation • Weakness of lower limbs • Past Medical History: Patient was found to be diagnosed case of 1. Hypertension 2. Type 2 diabetes milletus
- 4. • Family history: •Nil significant. • Past medication history: • Did not bring medication to hospital • Personal history: • Occupation:coolie Appetite:Normal • Income:400/- Bladder:Partially filled • Education:illiterate sleep:normal • Smoker/Alcoholic:negative
- 5. Physical examination: patient wasconscious and cohorent. • General examination: Systemic examination: • BP:140/90mm of Hg CVS:S1S2+ • PULSE RATE:102beats/min RS:BAE+ • FBS:301 mg/dl CNS:Nfnd.
- 6. CHIEF COMPLAINTS: • A56 yrs old female came to the hospital with the chief complaints of: 1. Fever since 10days 2. Burning micturation since 10 days 3. Weakness of lower limbs since yesterday. 4. Pain in the gluteal region
- 7. Laboratory investigation: • COMPLETEBLOOD PICTURE (21, 22,24&27-02-2021) • URINE ANALYSIS (21-02-2021) • PATHOLOGY TEST (21-02-2021) • USG GLUTEAL REGION (24-02-21) • USG ABDOMEN (24-02-2021)
- 8. Complete blood pictures: PARAMETERVALUES NORMAL RANGE HAEMOGLOBIN 7.2mg/dl 11-13g/dl W. B. C 23,800 4000-11000cells/mm³ BLOOD PRESSURE (B.P) 140/90 mm of Hg 120/80mm of Hg FASTING BLOOD SUGAR (FBS) 301mg/dl 70-100mg/dl BLOOD UREA 46mg/dl 7-20mg/dl
- 9. Urine Analysis: • Heamaturia •Albuminuria(+++) • Increased epithelial cells-15. 2H.P.F(1-5H.P.F) • Her pathological test was positive for KLEBSIELLA SPECIES (more than 10,00,000cfu/ml. • Her UDG of gluteal region showed SUBCUTANEOUS EDEMA. • Her USG abdomen showed mild hepatomegaly
- 10. Subjective Evidence 1. Fever 2.Burning micturation 3. Weakness of lower limb 4. Pain in gluteal region Objective Evidence • Leucocytosis(23, 800cells/mm³) • Blood urea(46 mg/dl) • Albuminuria • Hematuria • Klebsiella species • Subcutaneous edema in gluteal region
- 11. Assessment or Diagnosis K/C/OTYPE 2 DIABETES MELLITUS, HYPERTENSION WITH UROSEPSIS
- 12. Discussion • UROSEPSIS Isa term used to describe a type of sepsis that is caused by the urinary tract infections. • It is often a complication caused by the untreated urinary tract infection. • It requires immediate medical care to avoid life threatening conditions. • Aetiology: • Urethral catheres/urine tubes • Bacterial infections • Respiratory tract infections(pneumonia) • GI infections, surgery, perforation.
- 14. Signs and symptoms •Fever and chills • Frequent urination • Burning micturation • Severe abdominal pain, pelvic and back pain. • Shortness of breath • Fall in pulse rate etc
- 15.
- 16. Pathophysiology • Thebacteria spread from urethra into bladder Where they multiply causing the infection. • If the urinary tract infection is untreated then ot leads to the complications such as urosepsis. • Sometimes urosepsis also occur because the bacteria present in the bladder had multiply to an unhealthy level. • When the increase levels of bacteria reaches to blood circulation it causes blood poisoning (sepsis) • The sepsis caused from urinary tract infections is urosepsis.
- 17. Symptoms: • Antibiotics • Antipyretic&analgesic • Furosemide • vasopressors Fever Shortness of breathe Burning micturation Pain in abdomen, back region Fall in pulse rate
- 18. Prognosis:Day-01 Physical examination: • PR:96bpm •RR:18bpm • CNS:NFND • CVS:S1S2+ • B.P:120/80mm of Hg • SPo2:97% • GRBS:218 mg/dl Treatment • Inj. Piptaz-4. 5g-IV-BD • Inj.Pantop-40mg-IV-OD • Inj.Human Actrapid-6U-TID • T.PCT-650mg-TID • T.Bc-OD-PO.
- 19. Day-2 to Day-3 Physicalexamination • PR:102bpm • Pt:c/c • Spo2-98% • P/A-Soft • CNS:Nfnd • B.P:140/90mm of Hg Treatment • Inj. Safezone-1. 5g-IV-BD • Inj.Metrogyl-100ml-iv-Bd • Inj.PCT-2amp-iv-Bd • Inj.Artesunate-120mg-IV-OD • Inj.Lasix-20mg-iv-Bd • Inj.Human Actrapid-8U-iv-tid • Inj.Pantop-40mg-iv-od • T.Amlo-5mg-po-OD
- 20. Day 04 andday 5 Physical examination • Pt:c/c • PR:96bpm • BP-110/80mm of Hg • CVS-S1S2+ • P/A-soft • CNS-Nfnd Treatment • Continue Same treatment • Inj.insultard-8U-iv-od(h/A) • Ink.MVI-1amp.
- 21. Day-06 and day-10 Physicalexamination • Pt:c/c • B.P-150/100 mm of Hg • PR:92bpm • Spo2:99% • CVS:S1S2+ • RS:BAE+ • P/A:soft Treatment • Continue same treatment • T.Gabapin-100mg-PO-Tid
- 22. Discharge Medication: • Inj.Human Actrapid-12U-Tid • T.Udiliv-100mg-po-Bd • Inj.Human insultatd-8U-IV-OD • T.Pantop-40mg-po-od • T.Diclo-25mg-po-SOS • T.PCT-500MG-PO-SOS • T.BC-PO-OD • T.Ca+T.Vit-D-PO-OD. • Patient is sensitive to ampicillin, salbactum, ceftriaxone, levifloxacin • So prescribed with NITROFUTANTOIN.
- 23. Drug chart: S. NODRUG DOSE Route Of Administration FREQUENCY INDICATION DURATION 01 Inj. Metrogyl 100ml IV BD Antibacterial &antiprotozoal 9days 02 Inj. Safezone 1.5g Iv BD Antibiotic 9days 03 Inj. PCT 2amp Iv TID Analgesic&Anti pyretic 3days 04 Inj. Artesunate 120mg Iv OD Antimalarial 8days 05 Inj. Lasix 20mg Iv BD Diuretic 9days 06 Inj. pantop 40mg Iv OD Proton pump inhibitors 10days 07 T. Amlo 5mg Po OD Anti hypertensive 9days 08 Inj. Human Actrapid 8U Iv TID Short acting insulin 10days
- 24. S. NO DRUGDOSE ROUTE OF Adm FREQUENCY INDICATION DURATION 09 Inj. Insultatd 8U IV OD Isophane insulin 6days 10 Inj. MVI 1A Iv OD Multivitamin supplement 6days 11 T. Gabapin 100mg Po TID Anticonvulsant (good for treating nerve pain) 4days 12 13 14 15
- 25. Drug interactions: 1. Furosemide+insultard •Furosemide when given along with any anti diabetes drug causes diminish in the activity of insultard. • This causes increase in hyperglycemic levels and onset of glucose intolerance, preexisting diabetes conditions worsen. 2.Pantaprazole+Furosemide Chronic use of pantaprazole(proton pump inhibitors) induce hypomagnesemia., riskay be increase during use of concomitant diuretics. ADRs include-tetany, seizures, atrial fibrillation, Qtabnormal intervals.
- 26. Critical Evaluation • Thegiven prescription was inappropriate to treat the patient symptoms because drug interactions were seen. • Hence the given prescription was irrational.
- 27. Patient counselling: • REGARDINGDISEASES: • Urosepsis is a term used to describe a condition that occurs because of urinary tract infections. • It is often a complication caused by untreated urinary tract infections. • When the bacteria in urinary tract multiplies to a unhealthy level and reaches into systemic circulation then it causes urosepsis. • HYPERTENSION: • It is defined as the elevated blood pressure more than 120/80 mm of Hg
- 28. REGARDING MEDICATIONS: • T.PCT-500mg. • Mechanism of Action:
- 29. • Adverse effectsof pct: 1. Minore effects:rashes 2. Hives 3. Itching 4. Tiredness 5. Nausea. 6. Serious effects:heamaturia 7. Decreased urine output 8. Jaundice and sore throat USES: Used to treat aches and pains Used to lower body temperature.
- 30. 2) inj. Safezone •MOA:It acts by inhibiting enzymes transpeptidase which is essential for the synthesis of cell wall of bacteria. • ADR:Shortness of breathe • Pain, tenderness, hardness where injection was injected. • 3) Metronidazole: • MOA:It is a antibacterial and antiprotozoalprotozoal antibiotic that acts by inhibiting nucleic acid synthesis there by causes destruction of DNA of microbial cells. • ADR:Thromboplebotis, mettalic taste, nausea &vomiting. • Use:it’s used to treat protozoal and bacterial infections. •
- 31. • Artesunate: • MOA:Itis a prodrug which after ingestion get converted to it’s active form dehydroartemisinin . It act by inhibiting the enzyme glutathione –S-transferase enzyme(membrane protein) as a result decrease in glutathione cause death of protazoa. • ADR:RBC destruction and allergic reaction. • Use:used to treat malarial infections
- 33. • Uses:furosemide isused to treat edematous conditions. • It is also to treat to lower high blood pressure.
- 34. • Piptaz. Inj •MOA:It acts by inhibiting bacterial cell wall synthesis by binding to one or more penicillin binding proteins. • ADR:phlebitis, erythema, anemia and hepatitis. • Use:it is used to treat infections cause by resistant organisms. • GABAPIN.T • MOAUse:IT is class of drugs belonging to anticonvulsant but in conditions of pain it acts by changing the way that nerve send messages to brain. • Bu changing the way messages are send it reduce pains. • ADR:Allergic reaction, kidney disease, suicide thought and respiratory depression • Use:it is used to treat posttherapeutic neuralgia • Pain caused by damaged nerves
- 35. • Human Actrapid.Inj • MOA:Insulin acts by binding to insulin receptors on liver, muscle &fat tissue and increase uptake of glucose from the bloodstream there by decreasing insulin levels in blood. • Adr:Anxiety, nervousness, hypoglycemia and tiredness. • Use: it is used to treat type 2 Diabetes Mellitus. • GOALS ACHIEVED:
- 36. LIFE STYLE MODIFICATIONS: 1.Keep your genital area clen 2. Drink more fluids(2to4 quarter each day) to flush out bacteria. 3. Dont drink fluid that irritate bladder such as alcohol, citrus juices and caffeine. 4. Place warm pad on your abdomen to minimize bladder pressure