Emilio Aguinaldo College- College of Medicine

Department of Pharmacology
Clinical Pharmacology Case (Teachers Guide)
October 28,2015
I.

The Case

General Data:
This is a case of TA, 53/F from Manila who came in due to fever.
History of Present Illness:
Three weeks prior to admission patient waded in flood waters
One week prior to admission- patient then experienced flu-like symptoms.
Patient was also noted to be febrile and reported to have nausea, vomiting and
general body malaise. Patient self medicated with Paracetamol affording temporary
relief of symptoms. There was no consult done.
Five days prior to admission- Still with above symptoms, patient now complaints
of calf pain. Patient was also noted to be jaundiced. Patient however, allegedly said
to still have good urine output.
Two days prior to admission- still with above symptoms but patient now noted to
have decrease urine output (estimated<500ml/day).
One day prior to admission- patient became dyspneic hence consulted at
Medical Center Manila.
Review of Systems:
General survey: (-)weight loss, (-)heat/ cold intolerance, (-)loss of consciousness, (-)
behavioral changes
HEENT: (-) colds, (+) headache, (-) BOV, (-) hearing loss, (-) cough (+)conjunctival
suffusion
Pulmo: (-)hemoptysis
CVS: (+)chest pain (-)PND (-)orthopnea (+)palpitation
GI: (-) hematemesis, (-)constipation (-) diarrhea
GU: (-)dysuria, (-)hematuria, (-)pyuria, (-) polyuria, (-)polydipsia, (-)nocturia,
Extremities: (-)cyanosis, (-) tremors, (-) joint pains
Past Medical History
(-) HTN, DM, bronchial asthma, thyroid disease, kidney disease, PTB, allergies
Family Medical History:
U/R
Personal and Social History
Non-smoker

 Non-alcoholic beverage drinker

Unemployed
Physical Examination:
General: conscious, coherent
VS: BP 110/40
HR 84
RR-20
Temp- 37c
HEENT: pink conjuctivae, icteric sclerae, jaundiced
C/L: clear breath sounds
Heart: adynamic precordium, normal rate, regular rhythm
Abdomen: flat, soft, nontender
Extremities: grossly normal, no cyanosis, no edema but with calf tenderness
Neuro Exam: E/N
Laboratories:
12L ECG

Normal sinus rhythm

CBC

Hgb109, Hct0.33, WBC21 (N0.93, L0.01), plt106

Blood
Chemistry

Alk phos 150

Ca7.9 (low
BUN 86
Crea698 (high)

Alb22

ALT58

AST79

Na128 (low)
K3.6

TB9.36
DB8.37 (high)

TP4.9
IB0.99

ABG

pH7.21, pCO2 19, pO2 95, HCO3 7.6, O2sat 96%

U/A

pH 6.5, SG 1.020, CHO trace, CHON+2, WBC TNTC, RBC 2-8

Trop I

Negative

PT

Pt 13.8, Cx 11.8, act0.56, INR1.21

PTT

Pt 30.7, Cx 28.8

Hepatitis
profile

HBsAG: NR, anti-HBs: NR, anti-HCV:NR, anti-HAV IgM: NR

II. Questions:
1.
2.
3.
4.

What is the diagnosis?

What is/are your differential diagnose/s?
What is the pathophysiology of the patient's disease?
What are the drugs available for the treatment of this condition and prescribe
your P drug/s based on efficacy, safety, suitability and cost?
5. Discuss the non-pharmacologic management of the patient
6. Are there any preventive aspects you can institute to this patient?
Chemoprophylaxis? Available vaccine?