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VSDCase Presentation

By:Mohammed Adel

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Content• Case overall view• Problems list• Labs & clinical findings• Diagnosis • Pharmacotherapeutic management• Recommendations to be reported

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Case overall view A.Z. is a 4month old, 6Kgs male infant admitted with cough, fever and difficulty of breath. Upon examination he is found cyanosed and dyspneic. The symptoms started 2 wks ago and the parents were referred to the hospital by external physician.

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Problem list• Fever • Dyspnea • Grunting • Chest infection• Cyanosis • Mild jaundice • Decreased feeding

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Labs & clinical findings• Na+ 141mmol/L• K+ 5.06mmol/L• SCr 0.6mg/dL• Urea 32 mg/dL• Alb. 3.9 g/dL• PT 14.9 Sec

• PTT 46 Sec.• INR 1.45• ALT 18 IU/L• AST 38 IU/L• Bili. T. 0.6 mg/dL• Hgb 10.7g/dL

• PLT 388×103/mm3

• WBC 10.6 ×103/mm3

Objectiv

e

data

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Labs & clinical findings• Temp. 39°C• BP 90/70 mmHg• HR 140Bpm• Tachypnea • Pan systolic murmur• Pneumonia patches on X-ray• Large tender liver

Objectiv

e

data

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Labs & clinical findings

• Echo revealed• VSD 5.3 mm• Dilated LV• Severe TR• PHTN 45 mmHg

Objectiv

e

data

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Diagnosis

The patient suffers VSD complicated with acute episode of heart failure and pneumonia

Assessm

ent

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Pharmacotherapeutic management

• Cefepime 1gm diluted in 10 ml NS then 3ml IV q12hrs

• Amikin 500mg diluted in 5ml N.S then administer IV 45” q12 hrs

• Lasix 4mg IV Q6hrs • Calcium gluconate 6ml+ 10ml

D5W q8hrs• Capoten® 6.25mg tablet1X3• Vit.K injection as .5amp d

Q24hrs

• Temporal syrup 2ml 1X4• .5ml farcoline+ .5ml

atrovent+ 2ml N.S nebulizer Q4hrs

• 1 ml dopamine +7ml dobutamine on 100 ml NS < rate 7dps/min

• Lanoxin syrup 45” Q12hrs• Potassium syrup 2ml q7hrs

Plan

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Recommendations to be reported

Drug interactions:Calcium salts decrease the effect of dobutamine

Good reliability

Class C interactions

with fair reliability

Plan

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Recommendations to be reported

Precautions & Monitoring :

Captopril / furosemide• Monitoring K levelLanoxin /furosemide/ Ca gluconate• ECG for arrhythmia

Plan

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Recommendations to be reported

Pharmacotherapeutic intervention required:Amikin dose should be switched to 30mg Q8hrs (5-7mg/kg/dose

Q8hrs)Lanoxin dose should be adjusted to 60mcg/day (10-15 Mcg/Kg)Lasix dose sould be increased to 6mg/ dose intermittent IV

doses (1mg/Kg/dose)Capoten dose should be decreased to 2mg Q8hrs

(.3-.5mg/Kg/dose Q8hrs)Consider Hemoglobin correction

Plan

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Thank You