ALD WITH ASCITES by Vaibhav

A Case presentation
on
ALCOHOLIC LIVER DISEASE
Presented by:
VAIBHAV PATIL
Pharm.D. 4TH year
Reg no- 14Q1809
Demographic details:
IP NO - 201832911
SEX - Male
AGE - 40years
WARD - General medicine unit-1
DOA - 27-11-2018
PRESENTING COMPLAINTS :
C/O breathlessness and abdominal distension since 10days.
HISTORY OF PRESENTING COMPLAINTS

H/O abdominal distress since 1 month.
H/O blood stools.
PAST HISTORY :
Nothing Significant
PERSONAL HISTORY
Chronic smoker, Alcoholic since 15years.
GENERAL EXAMINATION :
 Temperature : Afebrile
 Blood pressure : 130/80 mmHg
 Pulse : 80 Bpm
 Respiratory rate : 18 cpm
SYSTEMIC EXAMINATION :
Respiratory System : NVBS heard
 Cardiovascular System : S1 S2 Heard
 Abdominal Examination : Abdomen distended
Central Nervous System : pt is consciousness
ADVICE FOR :
CBC, Platelets, RFT, LFT, urine, ECG.
PROVISIONAL DIAGNOSIS:
Alcoholic liver disease

Laboratory data:
Test Test value Ref .value
(Roger walker)
Hb 9.2gm/dl 13-18gm/dl
RBS 102 mg/dl 80-140mg/dl
WBC 6,400cumm 4000-11,000cumm
Polymorphs 64% 40-70%
Lymphocytes 30% 5-15%
monocytes 02% 2-10%
Eosinophils 04% 2-10%
Sr.Creatinine 1.2mg/dl 0.7-1.4mg/dl
Blood urea 38.84mg/dl 15-45mg/dl
Test Test value Ref value
Uric acid 3.8mg/dl 3-7mg/dl
Pus cells 1.2p.v.f 0-4p.v.f
Epi.cells 1.2p/v.f 0-4p.v.f
Billirubin 2.67mg/dl 0.2-1.2mg/dl
Albumin 2.30gm/dl 3.5-5gm/dl
SGOT 45 IU/L 5-35IU/L
SGPT 22.98IU/L 5-45IU/L

DAY-1 TREATMENT
S.No Trade Name Generic Name Dose & ROA Day 1
1. INJ. HEPAMERZ L ORNITHINE 5gm/ 10ml /IV *

L ASPARTATE od
2 Inj. Rantac Ranitidine 50mg IV BD *
3 Inj. taxim Ceftotaxim 1g IV BD *
4 Inj. Emset Ondansetron 4mg IV BD *
5 Ivf. NS Normal saline 1pint iv/bd *
6 O2 inhalation 4th hourly *

DAY-2
ADV:
Syr. duphalac
Ivf Dextrose + MULTI VITAMIN INJECTION
DAY 3
G/C better
ADV:
Tab. Lasilactone 20mg bd
Cap. Nervijen plus od
rest cst..
SOAP ANALYSIS :
Subjective evidence:
- c/o breathlessness
-Abdominal distention
-k/c/o chronic parenchymal liver disease
Objective evidence:
-Decreased Hb, RBS & Albumin
-increased lymphocyte, bilirubin(T & D)
ASSESMENT
• As Per Subjective And Objective Evidence The Patient

is diagnosis as Alcoholic Liver disease with ascites.
TREATMENT CHART
S.NO TRADE NAME GENERIC NAME DOSAGE/ROA INDICATION
1. INJ.TAXIM CEFOTAXIM 1g BD ANTIBIOTIC

2. INJ. RANTAC RANITIDINE 50mg iv/bd H2 ANTAGONIST
3. INJ. HEPAMERZ L ORNITHINE 5gm/ 10ml /IV HEPATIC
L ASPARTATE PROTECTOR
4. O2 INHALATION 4TH HOURLY

5. IV FLUID NS NORMAL SALINE 1 pint IV BD FLUID
REPLENISHER
6. INJ.EMSET ONDANSETRON 4mg/IV/BD ANTI EMETIC
7. SYP. DUPHALAC LACTULOSE SOLN 15ml/TID LAXATIVE
8. INJ.DEXTROSE+MVI DEXTROSE+MULTIVITAMIN 1pint IV/od FLUID
REPLENISHER
9. TAB. LASILACTONE FUROSEMIDE&SPIRONOLA 20mg/BD DIURETIC
CTONE
10. CAP.NERVIJEN PLUS BENTOTIAMINE OD VITAMIN B12
PLAN
GOALS OF TREATMENT
Symptomatic relief of breathlessness & abdominal
distension.
Avoid hepatotoxic medications.
Regular laxatives to avoid encephalopathy
Improving the quality of life.
Manage the disease progression.
Prevent complication.
.
Complications of the disease:
• Portal hypertension.
• Swelling in legs & abdomen.
• viceral Bleeding.
Other complications include,
• malnutrition.
• Hepatic encephalopathy.
• Jaundice.
• Increased risk of liver cancer.
Monitoring parameters:
DISEASE RELATED
 Strict observations on LFT & RFT parameters.
 Urea and electrolytes monitoring to detect impending
hypokalaemia or hyponatraemia.
Thrombocytopenia, leukopenia and neutropenia with
splenomegaly.
DRUG RELATED PROBLEMS

 Drug-Drug & Drug –Food reactions are found
Drug interactions:
INTERACTING DRUGS SEVERITY CAUSES MANAGEMENT
Cefotaxime<>furosemi moderate Cephalosporin Dose adjustment and
de antibiotics cause frequent monitoring
kidney problem ,
with furosemide
increase risk
Furosemide <> Moderate May increase risk Pt should advice to
lactulose of dehydration and exercise and increase in
electrolyte fiber diet
abnormalities
Ondansetron<>lactulos Moderate Ondansetron can Recommended dosage
e cause hearth and duration of use
rhythm this risk should not be exceeded
increased with use
of laxative
PATIENT COUNSELLING :
Regarding disease: disease and its complications.

About medication: indication of prescribed medicines,
possible side effects.
Life style modification:
a)complete abstinence of alcohol, smoking.
b)Take low sodium diet.
c)Low protein rich food.
Medication card:
Drugs Uses Possible side effects
furosemide Used to reduce extra fluid Blurred vision,
(edema) in the body constipation ,diarrhea
Cefotaxime Used to treat bacterial Swelling, redness, pain at
infection the injection site
Ranitidine Used to decreases stomach Headache, constipation,
acid production redness
ondansetron Used to prevent nausea Headache, dizziness,
and vomiting tiredness
spironolacto Used to treat swelling Drowsiness, dizziness,
ne caused by heart failure, diarrhea, nausea,
liver disease vomiting
Thank you..

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A Case presentation

HISTORY OF PRESENTING COMPLAINTS

Alcoholic liver disease

Uric acid 3.8mg/dl 3-7mg/dl

Pus cells 1.2p.v.f 0-4p.v.f

Epi.cells 1.2p/v.f 0-4p.v.f

Billirubin 2.67mg/dl 0.2-1.2mg/dl

Albumin 2.30gm/dl 3.5-5gm/dl

SGOT 45 IU/L 5-35IU/L

SGPT 22.98IU/L 5-45IU/L

1. INJ. HEPAMERZ L ORNITHINE 5gm/ 10ml /IV *

3 Inj. taxim Ceftotaxim 1g IV BD *

4 Inj. Emset Ondansetron 4mg IV BD *

5 Ivf. NS Normal saline 1pint iv/bd *

6 O2 inhalation 4th hourly *

• As Per Subjective And Objective Evidence The Patient

1. INJ.TAXIM CEFOTAXIM 1g BD ANTIBIOTIC

4. O2 INHALATION 4TH HOURLY

DRUG RELATED PROBLEMS

Regarding disease: disease and its complications.

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