Decompensated Chronic Liver Disease-2

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CASE PRESENTATION ON

DCLD WITH ASCITES


P R ESENTED B Y:
MA LIHA MUZA FFER
PHA R M D 6 T H YEA R
DEMOGRAPHIC DATA
NAME: XYZ
AGE: 64 YEARS
GENDER: MALE
DOA: 29/2/2024
SUBJECTIVE DATA
CHIEF COMPLAINT:
65 year old/ chronic alcoholic presented with a c/o abdominal distension since 1 week. C/o
decreased urine output since 1 week. Patient was apparently normal 1 week back then presented
with complaints.
HISTORY OF PRESENT ILLNESS:
C/o decreased urine output (200 ml/day). C/o pedal edema B/L, right>left, pitting type, slow
filling. C/o SOB + grade II.
MEDICAL HISTORY:
k/c/o CLD/ hypothyroidism/ Hypertension.
MEDICATION HISTORY:
Amlodipine 5 mg and atenolol 50 mg.
OBJECTIVE DATA
Vitals D1 D2 D3 D4 D5 D6 D7
Temp Afebrile Afebrile Afebrile afebrile afebrile afebrile Afebrile
BP 120/70 120/70 120/70 120/70 120/70 120/70 120/70
PR 68/min 68/min 67/min 68/min 67/min 68/min 66/min
RR BAE + BAE + BAE + BAE + BAE + BAE + BAE +

SPO2: 97%
GRBS: 137 mg/dl
CNS: B/L pupil 3 mm RL
LAB INVESTIGATIONS
TESTS RESULTS NORMAL RANGE
Haemoglobin 9.8 14-17 g/dl
RBC 3.52 4.2-5.9 x 1012/L
WBC 11.65 4.0-10 x 109/L
Platelets 2 lakhs 150-350 x109/L
TSH 6.05 0.34-5.60 micro IU/ml
T3 0.41 0.87-1.78 ng/ml
T4 5.1 6.09-12.23 micro g/dl
Serum creatinine 1.15 0.6-1.2 mg/dl
BUN 10.70 8-20 mg/dl
TESTS RESULTS NORMAL RANGE
Na 128.4 135-145 mEq/L
K 3.08 3.5-5 mEq/L
Cl 89.5 95-105 mEq/L
Ca 7.0 8.5-10.5 mg/dl
Mg 1.47 1.5-2.4 mg/dl
ALT 22 0-35 units/L
AST 39 0-35 units/L
ALP 173 30-120 units/L
Albumin 1.77 3.3-4.8 g/dl
Vit B12 374 pg/ml 200-800 pg/ml
PT 18 sec 11-13 sec
INR 1.5 <1.1
❖Culture: No bacterial growth
❖Ascitic fluid: 16 U/L (ADA)
❖USG: Increased echo-texture with mild surface
irregularity gross ascites.
❖SPA doppler: Decreased PSV of main portal vein
?PHTN.
❖ASCITIC FLUID:
OTHER
INVESTIGATIONS Glucose- 133 mg/dl
Protein- 0.69 g/dl
Albumin- 0.29 g/dl
64 years old male/chronic alcoholic. K/c/o
ASSESSMENT hypothyroidism +
P/W DCLD with ascites.
TREATMENT
Drug Generic name Indication Dose Freq Roa Days

Inj Lasix Furosemide Loop diuretic 40mg BD IV 7 days


Tab Aldactone Spironolactone Aldosterone 25 mg BD PO 7 days
antagonist
Syp Lactulose Lactulose Constipation 15 ml H/S PO 7 days
Tab rifaximin Rifaximin DCLD 550 mg BD PO 7 days
Inj thiamine Thiamine (vit Supplement 100 mg in OD IV 7 days
B1) 100 ml
DNS
Drug Generic Indication Dose Freq Roa Days
name
Tab Thyronorm Thyroxine hypothyroidism 62.5 mcg BD PO 7 days
sodium
Tab PCM Acetamin Analgesic 500 mg SOS PO 7 days
ophen
Inj monocef Ceftriaxo Antibiotic 1 gm BD IV 5 days
ne
Protein powder Protien - 1 tps QID PO 3 days
PHARMACIST INTERVENTION
DRUG-DRUG INTERACTIONS:
FUROSEMIDE + CEFTRIAXONE: MONITOR THERAPY
• Furosemide may enhance the nephrotoxicity of cephalosporins.

ADVERSE DRUG REACTIONS:


No adrs were detected.
PATIENT COUNSELLING
•Reduce alcohol consumption.
•Salt restricted diet + high protein diet is recommended.
•Practice good hygiene.
•Follow doctor’s instructions.
•Take your medicines as ordered by the doctor.
•Get lots of rest.

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