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DATE : 19/10/10 SECTION : NEUROLOGY WARD : C7 BED NO : 26 REG.NO : 805145 GROUP B PREPARED BY:  NUR FADHILAH ARSHAD  NUR HAIDAR AKBAR  NABILAH JAMALUDIN.

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Presentation on theme: "DATE : 19/10/10 SECTION : NEUROLOGY WARD : C7 BED NO : 26 REG.NO : 805145 GROUP B PREPARED BY:  NUR FADHILAH ARSHAD  NUR HAIDAR AKBAR  NABILAH JAMALUDIN."— Presentation transcript:

1 DATE : 19/10/10 SECTION : NEUROLOGY WARD : C7 BED NO : 26 REG.NO : GROUP B PREPARED BY:  NUR FADHILAH ARSHAD  NUR HAIDAR AKBAR  NABILAH JAMALUDIN  CHUA SUE HOON  CHAI YEE YIEN  TAN SIN YEIN  NIK NUR NASEELA FATHIN NIK MOHD SABRI

2  Name: OO  Age: 46 years old  Gender: Male  Race: Malay  Date of admission: 7 th October 2010

3 Had:- Fever (3 days) Chills Tremors Do not had:- x Cough x Runny nose x Chest pain x Vomit x Shortness of breath x diarrhea

4  Diabetes mellitus  Hypertention

5 Name/Dose/Strength/RouteScheduleIndication T. Amlodipine 10mgODAntihypertension T. Vitamin B complex/Folate/ Ferrous fumarate 1/1 ODSupplement T. CaCO 3 500mgBDTreatment hyperphosphatemia T. Lovastatin 20mgONAntihyperlipidemic

6 DDM and HTN NNo renal disease, heart disease, and hematology disorder.

7  Allergic: No  Social History:  Smoking: stopped 1 year ago  Alcohol: No

8  Upon admission:  Temp: 37.5 ⁰ C  BP:75/56

9 Date/Time 4am( ⁰ C)8am( ⁰ C)12pm( ⁰ C)4pm( ⁰ C)8pm( ⁰ C)12am( ⁰ C) 13/ / / / / / /1037

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18 Date14/1016/1017/10 Urea (mmol/L) Creatinine (µmol/L) WBC (10 3 /µL)

19 RESISTANCESENSITIVITY Cloxacillin Fucidic acid Cotrimoxazole Rifampicin Erythromcin Vancomycin Gentamycin CULTURE TEST – MRSA (POSITIVE)

20 DrugIV Vancomycin 1g stat IV Vancomycin 1g stat IV Vancomycin 1g stat Administration13/10/10 (6.40pm)14/10/10 (11.00pm)17/10/10 (4.35am) Sampling time14/10/10 (8.30am)15/10/10 (11.50am)18/10/10 (9.30am) K + level (mmol/L) Na + level (mmol/L) BUN (mmol/L) Creatinine (µmol/L) Albumin (g/L) Therapeutic Range (µg/mL)15-20 Measured level (µg/mL) Comments:Level within range, can give 1g today (14/10) Above toxic range, give 1g on 16/10, 11pm (tomorrow) Still high, give 1g on 19/10

21  End stage renal failure  Grade IV bedsore

22 End Stage Renal Failure

23 Stage of Chronic Kidney Disease eGFR ml/min/1.73 m Stage 1: the GFR shows normal kidney function but the patient are already known to have some kidney damage or disease. For example, the patient may have some protein or blood in his/her urine, an abnormality of the patient kidney, kidney inflammation, etc. 90 or more Stage 2: mildly reduced kidney function AND the patient already known to have some kidney damage or disease. People with an eGFR of without any known kidney damage or disease are not considered to have CKD. 60 to 89 Stage 3: moderately reduced kidney function. (With or without a known kidney disease. For example, an elderly person with ageing kidneys may have reduced kidney function without a specific known kidney disease.) 45 to 59 (3A) 30 to 44 (3B) Stage 4: severely reduced kidney function. (With or without known kidney disease.) 15 to 29 Stage 5: very severely reduced kidney function. This is sometimes called end-stage kidney failure or established renal failure. Less than 15

24 Diabetes. Diabetic kidney disease is a common complication of diabetes. High blood pressure. Untreated or poorly treated high blood pressure is a major cause of CKD. However, CKD can also cause high blood pressure, as the kidney has a role in blood pressure regulation. About nine out of ten people with CKD stages 3-5 have high blood pressure. Causes of ESRF

25 Bedsore Alternative name : pressure ulcer An area of skin that breaks down when the patient stay in one position for too long without shifting your weight. The constant pressure against the skin reduces the blood supply to that area, and the affected tissue dies

26 Pressure sores are categorized by severity, from Stage I (earliest signs) to Stage IV (worst): Stage I: A reddened area on the skin that, when pressed, is "nonblanchable" (does not turn white). This indicates that a pressure ulcer is starting to develop. Stage II: The skin blisters or forms an open sore. The area around the sore may be red and irritated. Stage III: The skin breakdown now looks like a crater where there is damage to the tissue below the skin. Stage IV: The pressure ulcer has become so deep that there is damage to the muscle and bone, and sometimes tendons and joints.

27 Drug treatment in the ward Current Drug Therapy Oral

28 Drug NameDose/StrengthDuration startIndication Calcium Carbonate 500mg TDS 19/10/2010To remove excess phosphate in renal failure. It is used as a phosphate binder in the management of renal failure where it works by removing excess phosphate from the body. Benadryl15 mL TDS19/10/2010Antihistamine- Relieve itches that caused by excessive phosphate. Lovastatin20 mg ON10/10/2010It reduces the blood cholesterol level. This helps to prevent heart disease, stroke, and related diseases in people at increased risk.

29 Drug NameDose/StrengthDuration startIndication T.vitamin B complex Folate I/I OD14/10/2010It Vitamin B complex is used in vitamin B deficiency Syrup Lactulose15 mL BD14/10/2010It may take a few days for the full effect of the medicine to develop and relieve the constipation.

30 Drug NameDose/StrengthDuration startIndication IV Vancomycin1 g Stat13/10/2010The injection is used to treat certain severe infections that are resistant to other antibiotics. Parenteral

31 Formula used in the calculation:

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37 13/10/2010 Vancomycin therapy starts  1g stat given at 6.30pm 14/10/2010 Sampling is done at 8.30 am.  Serum level = 18.55mcg/ml; within range ( Therepeutic range = 15-20mcg/ml ) Therefore, next dose given was on the same day.

38 15/10/2010 Blood sampling is done at 11.50am.  Serum level = mcg/ml; which is above toxic level.  C min = C max e -keT Time ( Hour ) Serum Level ( mcg/ml)

39 Recommendation:  With held one dose.  Give 1g on the following day.  However, the next dose given was on 17/10/2010

40 17/10/2010 1g stat IV vancomycin is given at 4.35am 18/10/2010 Blood sampling is done at 9.30am  serum level = 26.24mcg/ml ; above toxic level  The calculated concentration after 24 hours is 17.92mcg/ml Therefore, the pharmacist recommends the next dose should be given on 19/10/2010.

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