Pharmacotherapeutics for Acute Renal Failure in Patient with DM and HTN

Pharmacotherapeutics-II DM, HTN with acute renal failure

Patient profile form Patient name: Neelamma patil I.P No : 5632 Unit : Unit VI Age : 60yrs Dept : Medicine Sex : Female DOA : 28/02/2013 DOD :06/03/2013 Present complaints :C/O, itchy skin lesions our both lower limbs since 1 month, b/l swelling of legs, oliguria since 10 days

Past medical history : DM,HTN -2years on prescription Past medication history: Tab metosartan, Tab Dianorm 80 ,Tab PiozMFG2 , Tab Anxit. Personal history: Diet :Veg Apeptite : Good Bladder and Bowel: Normal Sleep :adequate

Laboratory Investigations: RBC : 4.34 WBC : 4900 HB : 11.7 PLATELET COUNT : 1.53 ESR : 80 POLYMORPHS : 65 LYMPOCYTES : 33 BASOPHILS :00 MONOCYTES :00 ESINOPHILS :02 PCV : 36.5 MCV :84.5 MCH :27.0 MCHC :32.1

Laboratory data Biochemistry : RBS : 125mg% (60-140 mg%) Urea : 69.4 %(10-50mg%) Serum creatinine :3.5mg % Albumin : 3.4gm % Globulin :2.8 gm% Electrolytes : Sodium : 135.0 meq/L (135-153meq/L) Potassium : 4.2 meq/L (3.5-5.5meq/L) Calcium : 8.5 mg %

SOAP NOTE: SUBJECTIVE: C/O, itchy skin lesions our both lower limbs since 1 month, b/l swelling of legs, oliguria since 10 days. OBJECTIVE: DATE 28/2 1/3 2/3 3/3 4/3 5/3 6/3 BP 150/90 160/100 150/84 160/84 164/94 160/108 130/80 Pulse 82 86 80 82 84 82 80 ESR 80 (M<10,F<20) Due to infections Polymorphs 65 (40-60) Due to infections MCH 27( 32-36) Due to hypochromic anaemia

Y S A R E N O T A B L E T O E X C R E T E SR. CREATININE :- 3.5mg % DUE TO KIDNEYS ARE NOT ABLE TO EXCRETE Urea : 69.4 %(10-50mg%)DUE TO KIDNEYS ARE NOT ABLE TO EXCRETE

URINE EXAMINATION : Albumin : Absent Pus cells : 2-3 Sugar : Absent Epithelial cells : 3-4 DERMATOLOGY : O/E ,Multiple erythromatous papules seen over both extensor aspect of both legs & knee . ECOCARDIOGRAPHY & COLOUR DROPPLER REPORT: Valves :- mitral valve : mild annular calcification Aortic,tricuspid,pulmonary Normal

Chambers :- LV :Mild concentric LVH RV Normal RA-Normal LA-Normal Conclusion : Mild concentric LVH Normal resting Lvsystolic functions with LVE of 60% Type 1 diastolic dysfunction

ASSESSMENT:- PROBLEM LIST: 1. Itchy skin lesions 2. Type 2 DM 3. Essential HTN 4. B\L Swelling of legs 5. oliguria OBJECTIVE: 1) Itchy skin lesions : It occured due to diabetes i.e type 2 DM (Diabetic dermopathy). 2) Type 2 DM : It occcured due to insulin resistance & may be due to increased glucose levels.

3) Essential HTN : It may be age related or asympatomatic. 4) B\L Swelling of legs : It may be due to sodium and water retention. 5) oliguria :It may be due to acute renal failure. PLAN : 1) DM : 1)Inj H.Actrapid all the days (Human insulin) 1-1-1 MOA: It acts by reducing the glucose levels. 2)Tab PiozMFG2 Pioglitazone HCL +Metformin+ glimepiride -1-0-1- last day only MOA : It acts by reducing the blood glucose levels & enhancing the insulin receptor sensitivity.

Therapy plan: Drugs Dosage Day s of treatment Trade name generic 7/2 8/2 9/2 10/2 11/2 12/2 13 14/2 Y Y Y Y Y Y Y Y 1)Inj H.Actrapid H.INSULIN 4 (1-1-1) Y 2)Tab PiozMFG2 Pioglitazone HCL +Metformin+ glimepiride (1-1-1) Y Y Y Y Y Y Y Y 3)Tab. Metosartan 50 metoprolol + telmisartan 50mg (1-0-1) Y Y Y Y Y Y Y 4) Elovera lotion Vit E & Aloevera 1 -0-0 Y Y Y Y Y Y Y 5)Tenovate cream clobestol (0-0-1) Y Y Y Y Y Y Y Y 6)Tab.Atarax 25 Hydroxyzine 25mg 1-0-1 Y Y Y 7)Inj noradrenaline noradrenaline 4ml per hour Y Y Y Y Y Y y y 8)Inj lasix furosemide 40mg (1-0- 0) y Y Y Y Y Y Y Y 9)Inj.Augumentin Amoxcillin+clavunica cid 1.2gm (1-0-1) Y Y Y Y Y Y y y 10) Inj.Pan Pantaprazole 40mg (1-o-0)

2)HTN : 1)Tab. Metosartan 50 metoprolol + telmisartan -50 1-0- 0 all the days MOA: It is a beta blocker, it blocks the adrenergic receptors present in the smooth muscles. 3)Dermatis (itchy skin lesions): 1)Elovera lotion Vit E & Aloevera M-0-0- except 1stday 2)Tenovate cream clobestol-0-0-N-except 1st day MOA:-Clobestol is a corticosteriod ,it reduces pruritic manifestations & inhibits prostaglandins & leukotrienes synthesis

3)Tab.Atarax 25 Hydroxyzine-1-0-1-25mg-all days MOA:- It act as antihistamine,it can be used for treatment of severe cases of itching. 4) Acute renal failure : 1)Inj noradrenaline -4ml per hour - 3days MOA: they cause vasoconstriction in the renal vasculature and increases the renal perfusion. 2)Inj lasix furosemide- 1-0-0- 40mg-all days Moa :acts on DCT and CD .inhibits Na-K-2Cl cotransport and causes excretion of sodium and water. 5)Others: Inj.Augumentin-Amoxcillin+clavunicacid-1.2gm-1-0-1-all the days. MOA:-These are the betelactamase inhibitors & used for prophylaxis purpose. 2)Inj.Pan-pantoprazole-40mg-1-0-0-all the days MOA: It s a proton pump inhibitor ,it reduces gastric acid secreation.

DISCHARGE DRUGS: 1)Tab pan 40 40mg-7 days-1-0-1 2)Tab Augumentin -625mg-7 days-1-0-1 3)Tab PiozMFGz-7 days-1-0-1 CLINICAL PHARAMACIST INTERVENTIONS & SERVICES PROVIDED : DDI s : 1)Insulin + metoprolol moderate hypoglycemia or hypertension

PATIENT COUNSELLING FOR : DISEASE : 1) Monitor BP regularly 2) Kidney assement 3) Foot care 4) Eye care 2)MEDICATION :- 1)PAN 40 : Should be taken BEFORE meal 2)Metfomin : Should be always taken along with meals & avoid alcohol consumption. 3)LIFE STYLE: 1)Exercise regularly 2)Reduce or avoid the sugar content in food 3)Monitor your blood glucose regularly 1)