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VSD
Case Presentation
By:
Mohammed Adel
1
Content
• Case overall view
• Problems list
• Labs & clinical findings
• Diagnosis
• Pharmacotherapeutic management
• Recommendations to be reported
2
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.
3
Problem list
• Fever
• Dyspnea
• Grunting
• Chest infection
• Cyanosis
• Mild jaundice
• Decreased feeding
4
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
5
• 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
Labs & clinical findings
• Temp. 39°C
• BP 90/70 mmHg
• HR 140Bpm
• Tachypnea
• Pan systolic murmur
• Pneumonia patches on X-ray
• Large tender liver
6
Labs & clinical findings
• Echo revealed
• VSD 5.3 mm
• Dilated LV
• Severe TR
• PHTN 45 mmHg
7
Diagnosis
The patient suffers VSD complicated with acute episode of
heart failure and pneumonia
8
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
9
• 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
Recommendations to be reported
Drug interactions:
Calcium salts decrease the effect of dobutamine
Good reliability
10
Recommendations to be reported
Precautions & Monitoring :
Captopril / furosemide
• Monitoring K level
Lanoxin /furosemide/ Ca gluconate
• ECG for arrhythmia
11
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
12
Thank You
13

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pediatrics case VSD

  • 2. Content • Case overall view • Problems list • Labs & clinical findings • Diagnosis • Pharmacotherapeutic management • Recommendations to be reported 2
  • 3. 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. 3
  • 4. Problem list • Fever • Dyspnea • Grunting • Chest infection • Cyanosis • Mild jaundice • Decreased feeding 4
  • 5. 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 5 • 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
  • 6. Labs & clinical findings • Temp. 39°C • BP 90/70 mmHg • HR 140Bpm • Tachypnea • Pan systolic murmur • Pneumonia patches on X-ray • Large tender liver 6
  • 7. Labs & clinical findings • Echo revealed • VSD 5.3 mm • Dilated LV • Severe TR • PHTN 45 mmHg 7
  • 8. Diagnosis The patient suffers VSD complicated with acute episode of heart failure and pneumonia 8
  • 9. 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 9 • 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
  • 10. Recommendations to be reported Drug interactions: Calcium salts decrease the effect of dobutamine Good reliability 10
  • 11. Recommendations to be reported Precautions & Monitoring : Captopril / furosemide • Monitoring K level Lanoxin /furosemide/ Ca gluconate • ECG for arrhythmia 11
  • 12. 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 12