Presented By, Mr Amol Lavate

M.Pharm 1st year pharmacy practice, KLE’S college of pharmacy, Belgaum.

CONTENTSPatient ProfileSubjective EvidenceObjective EvidenceLaboratory DataDiagnostic TestsProvisional DiagnosisAssessment of 1) Therapeutic Goals 2)Therapy

indicated3) Current TherapyTherapeutic MonitoringToxicity MonitoringPlanningPatient Counseling

Patient ProfileI.P.# - 332301Age - 50yearsGender - Female Date of Admission - 30/09/2009Date of Discharge - 05/10/2009

Subjective EvidenceObjective Evidence Subjective Evidence

C/O Fever, nausea and Vomiting Fever with chills since 3 days, Vomiting since

1day Objective Evidence

(Test done one day before admission)Showed weakly +ve for DenguePlatelet count -- 4000/cu.mm (Decreased)White Blood Cell -- 3000/cu.mm (Decreased)

Laboratory DataDate 30/09/09 02/10/09 03/10/09 04/10/09

Haemoglobin

(12 – 14gm %) 7gm % 7.1gm %

Packed cell

volume (PCV)

(35-45%)

20.3% 23.2% 31%

Diagnostic TestsProvisional DiagnosisDiagnostic TestsMalaria parasite (Kit) - +ve for P.Vivax

+ve for P.falciparum(Gametocyte ring forms & Schizonts seen) Provisional Diagnosis Malaria with leucopenia and

thrombocytopenia

Assessment of1) Therapeutic Goals

-To alleviate symptoms -To prevent relapse and spread

2)Therapy indicated-Diagnostic tests done

-Rational antimalarial therapy given

Current Therapy Name, Strength, Route, Dose

Date started Date stopped Remarks

Inj. Ondansetran 4mg 1-0-1

30.09.09 02.10.09 Antiemetic

Inj. Ranitidine 50mg

1-0-1

30.09.09 01.10.09 Antihistamine

Inj. Artesunate 120mg 1-0-1

30.09.09 05.10.09 Antimalarial

Tab. Primaquine 15mg 1-0-0

01.10.09 continued Antimalarial

Tab. Doxycycline 150mg 1-0-1

01.10.09 05.10.09 Antimalarial

Tab. Ranitidine 150mg 1-0-1

01.10.09 05.10.09 Antihistamine

Therapeutic Monitoring

.Symptomatically improved

Toxicity Monitoring

Primaquine nausea, vomiting, haemolytic anaemia(G6PD Deficient), Thrombocytopaenia, leucopaenia

Doxycycline nausea, GIT upset, haemolytic anaemia,

Thrombocytopaenia.

PlanningDischarge Medication

Tab Primaquine 15mg 1-0-0 10 days Tab Vitamin c (chew) 500mg 1-0-0 10 days Tab Paracetamol SOS

Follow up after 15 days

Patient Counseling-Disease-Medication-Life style

Thank you