A CASE PRESENTATION ON

N S A I D INDUCED ACUTE
KIDNEY INJURY

• PRESENTED BY

• 172820122
 PATIENT DEMOGRAPHIC DETAILS

NAME: Mrs.X AGE : 22

SEX : FEMALE MRD.No: 25669

DOA :11.12.19 DOD :16.12.19

DEPARTMENT : NEPHROLOGY WARD : OLD PAYWARD

NO. OF HOSPITAL STAY : 6 DAYS BMI :27.1 Kg per square cm

REASON FOR ADMISSION

Referred from another hospital for treating renal impairment

H/o pedal edema and fever for past week.
PAST MEDICAL HISTORY

Patient had a habit of taking Diclofenac frequently for pain

SOCIAL AND FAMILY HISTORY

Nil

PERSONAL HISTORY

APPETITE : NORMAL FOOD HABIT :MIXED

URINATION :NORMAL SLEEP : NORMAL

BOWEL HABIT :NORMAL WEIGHT CHANGE : GAINED

 VITALS DURING THE TIME OF ADMISSION

TEMP : 98.6 F RR : 22 BEATS PER MINUTE

PULSE : 75 BEATS PER MINUTE BP :120/70 mmHg

CLINICAL/SYSTEMIC/ PHYSICAL EXAMINATION

GENERAL :Normal DERMATOLOGY : Normal

CVS : S1 S2 + NEUROLOGY : WNL

LUNGS : Clear GIT : P/A soft, no organomegaly

PROVISIONAL DIAGNOSIS
AKI??? NSAID INDUCED??
 VITALS MONITORING CHART

NORMAL
VITALS 11.12 12.12 13.12 14.12 15.12 16.12
RANGE

BP 120/80 120/80 120/80 120/80 120/80 120/80 120/80 mmHg

PULSE 80 76 78 74 72 72 72 beats per min

20 breaths per
RR 22 24 24 22 22 22
minute

TEMP 98.6 98.6 98.6 98.6 98.6 98.6 98.6 F

SPO2 99 98 97 99 97 99 95-100%

LABORATORY INVESTIGATION ORDERS

• HAEMOGRAM
• LFT
• RFT AND SERUM ELECTROLYTES
HAEMOGRAM

REFERENCE
TEST 11/12 12/12
RANGE
HAEMOGLOBIN 9.7 9.5 12-15g/dL
PCV/HCT 27.8 - 35.5-44.9%
4500-1100
WBC 7270 -
cells/microlitre
1.5-3.5lakh
PLATELETS 2.35 2.62
cells/microlitre
MONOCYTES 3.9 - 3-7%

EOSINOPHILS 2.6 - 1-3%

ESR 84 0-30mm in first hr

RFT AND SERUM ELECTROLYTES

TEST 11/12 12/12 13/12 14/12 15/12 16/12 REFERENCE RANGE

UREA 78 78 69 53 42 30 8-20 mg/dL

CREATININE 5.8 5.7 3.6 2.2 1.6 1.1 0.7-1.3 mg/dL

SODIUM 126 128 135 144 145 143 136-145 meq/L

POTASSIUM 4.8 5.4 4.8 5.1 4.7 4.5 3.5-5.0 meq/L

CALCIUM 7.8 - - - - - 9-10.5 mg/dL

PHOSPHOROUS 6.5 - - - - - 2.5-4.5 mg/dL

LIVER FUNCTION TESTS

TEST 11/12 REFERENCE RANGE

T.BILIRUBIN 0.34 0.3-1.2mg/dL

D.BILIRUBIN 0.03 0-0.3mg/dL

I.BILIRUBIN 0.31 0.1-0.8mg/dL

SGOT 20 0-35 U/dl

SGPT 10 0-35 U/dL

ALP 115 36-92 U/dL

T.PROTEIN 5.1 6-7.8 g/dL

S.ALBUMIN 2.3 3.5-5.5 g/dL

S.GLOBULIN 2.8 2.6-3.5 g/dL

FINAL DIAGNOSIS

NSAID INDUCED AKI

STAT MEDICINE

• Inj. Pantop 40 mg i.v -11.12.19

• T.Dolo 650 mg -16.12.19

FLUID INPUT-OUTPUT CHART

DATE INPUT [ml] OUTPUT [ ml]

11/12 1500 1300
12/12 1700 1200
13/12 2000 1300
14/12 2100 1300

15/12 1800 1300

16/12 1800 1500

TREATMENT CHART

ROA-
BRAND NAME GENERIC NAME DOSE 11/12 12/12 13/12 14/12 15/12 16/12
FREQ

SODIUM
T.ACIDOSE 500mg oral-TDS + + + + + +
BICARBONATE

ALPHA KETO
T.ALPHALEAD 4.5g oral-TDS + + + + + +
GLUTARATE

oral-
T.QFOL FOLIC ACID 5mg - + + + + +
HS

N-ACETYL
Inj.MUCINAC 1.2g i.v- BD - + + + + +
CYSTNE

oral-
T.OMNACORT PREDNISOLONE 20mg - + + + - -
OD

Oral-
T.RANTAC RANITIDINE 300mg - + + + + +
OD

oral-
T.OMNACORT PREDNISOLONE 10mg - - - - + +
OD
DISCHARGE MEDICATIONS

GENERIC
BRAND NAME DOSE ROA FREQUENCY DURATION
NAME

N-ACETYL
T.MUCINAC 600mg ORAL 0-0-1 5 DAYS
CYSTINE

SODIUM
T.ACIDOSE 500mg ORAL 1-1-1 5 DAYS
BICARBONATE

ALPHA KETO
T.ALPHALEAD 4.5g ORAL 1-0-0 5 DAYS
GLUTARATE

RECCOMMENDATIONS

Review after 5 days at OPD with RFT reports

SOAP ANALYSIS
 SUBJECTIVE DATA

A 22 Year old female with MRD no.25669 was admitted in

Nephrology department on 11.12.19 with complaints of renal
impairment.The patient was referred from another hospital for
further treatment.She had a history of pedal edema and fever
throughout for the past week.On correction of the complaints, the
patient was discharged on 16.12.19
 OBJECTIVE DATA

ELEVATED PARAMETERS DECLINED PARAMETERS

Urea Sr.Albumin,protein
Creatinine Hb

Phosphorous PCV

ESR Calcium

ALP Sodium

ASSESSMENT
Based on subjective and objective data, the case was diagnosed as
NSAID induced AKI
 PHARMACEUTICAL CARE PLAN
1. T.ACIDOSE ( Sodium Bicarbonate) 500mg 1-1-1

• Reduces metabolic acidosis found in patients with CKD

• Reduces progression of CKD

• USES ; Acidosis , Indigestion

• ADR ; Flatulence , stomach cramps

2. T.ALPHALEAD ( Alpha keto glutarate ) 4.5g 1-1-1

• Helps in improving kidney functions

• Combines extra ammonia in the body with alphabet glutamate to reduce problems
associated with presence of too much of ammonia

• USES ; nephro disorders ,post traumatic recovery

• ADR ; lethargy , rashes

3. INJ. MUCINAC ( N-Acetyl cystine) 1.2 g 1-0-1

• Builds antioxidants thus protect and repairs from damage

• Prevents kidney damage caused by NSAIDs

• USES ; paracetamol poisoning, dry eyes

• ADR ;upset stomach,diarrhea,fatigue

4. T.OMNACORT ( prednisolone) 20mg/10 mg 0-0-1

• Synthetic corticoid

• Decrease immune response to various disease

• Reduces swelling and allergic reactions

• USES ; arthritis, cancer

• ADR ; heartburn, dizziness, acne

5.T.QFOL (Folic acid) 5mg 0-0-1

• To treat anaemia

• Uses; anaemia

• ADR; dark coloured stool, abdominal distention,weight loss

6.T.RANTAC (ranitidine) 300mg 1-0-0

• Reduces excess acid production

• Also reduces gastric refluxes

• Uses ;metabolic acidosis, stomach ulcer

• ADR ; headache,constipation sleepiness

POINTS TO PHYSICIAN

• Serum urea level was elevated even at the time of discharge.

DRUG INTERACTIONS

• DRUG-DRUG ; prednisolone and sodium bicarbonate >

decreases the action of prednisolone

• DRUG-FOOD ; folic acid and Alcohol > alcohol reduce the

absorption of folic acid
 PATIENT
COUNSELLING
 ABOUT DISEASE

• Acute Kidney Injury is a condition when the kidneys suddenly

stop working .This develops rapidly over a few hours or days .
It may be fatal. Its common in those who are critically ill and
hospitalised.

• Symptoms include urine retention, fluid - electrolyte

imbalance ,fatigue..etc
 ABOUT DRUGS
1. T.MUCINAC

• 600 mg tab, should be taken once daily for 5 days

• Can be taken with or without food

• Ensure completion of course

2. T.ACIDOSE

• To be taken thrice daily, better to be taken at fixed times

• Take the missed dose as soon as you remember, if its almost time for next dose ,then skip the missed dose

• Do not crush

3. T.ALPHALEAD

• One tab to be taken at night

• Can be taken with or without food

• Do not crush
 LIFESTYLE MODIFICATIONS

• Avoid alcohol consumption

• Smoking cessation

• Stop consumption of caffeinated drinks

• Mild aerobic exercise as routine

 DIETARY MODIFICATIONS
• Choose food with lower potassium content

1. Cauliflower

2. Pepper

3. Grapes

4. Apple

5. Strawberries

• Avoid products with added salt

1.frozen meat

2.canned soup

3.Fast food

• Limit phosphorous

1.oatmeal

2. Beans

3.Nuts
THANK YOU