Done by : Ahmed Fahad Basilim clinical pharmacist intern

Supervised by: Dr. Muna Filfilan

17 years old Saudi female . Came to ER. On 25/ 1/ 2009 complained of sore throat, productive cough and fever for 2 days back , also there is L.L edema and abdominal distension. The patient stopped her medication 2 days ago because its finished.

Past history:1 -Sickle cell anemia (SCA) on

regular blood transfusion .

2 -Old ischemic stroke.

3 -Nephrotic syndrome .

4 -Hyperlipidemia.

Past medication: 1 -Prednisolone 40 mg PO OD.

2 -Lasix 40 mg PO OD

3 -Aldactone 25 mg PO OD

4 -Aspirin 81 mg PO OD.

5 -Zocor 20 mg PO OD

Vital sign:Pulse: 105/ min mm/Hg 138/ 97:BP

RR: 20 Temp: 38.6 °C

:Investigation

.Abdomen: + ve ascites

.Nervous system: conscious

L pitting edema..Limbs: L

Primary diagnosis:

Recurrent nephrotic syndrome. -

Lab result: 25/1/ 2009

PT: 11.5 ( 10.4-12.6 )INR: 1PTT: 29.4 ( 25.9-36.6)

Lab result: 25/1/ 2009 PT: 11.5 (10.4-12.6)INR: 1PTT: 29.4 (25.9-36.6)

WBC: 30.7 (4.4- 11.3)

RBC: 1.39 (4.3- 5.5)HGB: 6.5 (11.5- 16.5)PLT: 454 (145- 400)

Lab result: 25/1/ 2009PT: 22.4 ( 18.5 )INR: 1.8PTT: 26.5 ( 31.6)

WBC: 30.7 (4.4- 11.3)RBC: 1.39 (4.3- 5.5)HGB: 6.5 (11.5-

16.5) PLT: 454 (145- 400)

Cr : No reagent.

LDL: 169 mg/dl ( 0 – 130 )AST: 53 u/L ( 15- 37 )LDH: 313 u/L ( 100- 190 )AlB: 1.9 g/dl ( 3.4- 5.9)

225 mg /dl ( 0 – 200) Choles:

Plan: 25/1/2009 -Abdo.U/S

-Urine analysis -Urine C.S

-CXR -PT/PTT

-serology - CBC

-Chemistry

-Septic screen blood C.S

Plan: 25/1/2009 -Abdo.U/S

-Urine analysis -Urine C.S

-CXR -PT/PTT

-serology -CBC-Chemistry

-Septic screen blood C.S

Prednisolone 40 mg PO OD -ASA 81 mg PO OD–

-Zocor 20mg PO OD Losec 20mg PO OD-

-Aldactone 25mg PO OD -Folic acid 2mg PO OD

-Aranesp 40ug S/C once/week

-Perfalgan 1g IV OD -Rocephin 1g IV OD

-Lasix 40mg IV OD

-D/C Losec 20 mg PO OD -D/C aldactone.

-Human Albumin 100 cc IV OD -Increase Lasix 40 mg IV BID

Urine report: 26/1/2009 -Appearance: yellowish , clear

-Protein: +++ -PH: 6 -Glucose: - -Occult

blood :++

-RBC: 15-20 -WBC: 15-25

-Crystal:- - Cast:+

-Bacteria:-

Blood report:

-No growth after 7 days .

Urine report: 26/1/2009 -Appearance: yellowish , clear

-Protein: +++ -PH: 6 -Glucose: - -Occult

blood :++

-RBC: 15-20 -WBC: 15-25 -Crystal:- - Cast:+

-Bacteria:-

Blood report:

-No growth after 7 days. T: 38 ° C

:Plan: 26/1/ 2009 -Hi stop 4mg PO OD Hs.

- Human albumin 100 cc IV OD

-Kafosed 10 cc PO TID

Lab result:27/1/2009

WBC: 20.20

RBC: 1.93PLT: 349HGB: 5.4

Lab result:27/1/2009

WBC: 20.20

RBC: 1.93PLT: 349HGB: 5.4

Cr: 0.7 Ca: 7.8 AST: 54 LDH: 288

Albmin: 2

:Plan: 27/1/ 2009 -Increase Rocephine to

2mg IV OD - Human albumin 100 cc

IV OD -Hydroxyurea 500 mg PO

OD -Increase folic acid to

5mg PO OD -Transfusion 2 units PRBC

Lab result:28/1/2009

WBC: 30.69

RBC: 3PLT: 448HGB: 6

:Plan: 28/1/ 2009 - Human albumin 100 cc

IV OD -Chemistry on Saturday

Lab result:31/1/2009

Cr: 0.4

Ca: 8.33AST: 38Albumin: 2.3

:Plan: 31/1/ 2009 - Human albumin 100 cc

IV OD -Zinnat 250 mg PO OD

-Stop Rocephine