CASE PRESENTATION ON PRES

WITH SEIZURES

R.G.NIKITHA
616175802026
V/VI Pharm. D,
Shri Vishnu college of Pharmacy.
A Female patient of age 17 yrs was admitted in the hospital with the
following complaints:

 C/O: Swelling of body and facial sufferness, back pain, headache

 O/E :Patient is concious and coherent

General condition: fair
BP : 140/80mmHg
PR : 78 BPM
RR : 24 CPM
P/A : Soft
Lungs : BAE
Temperature : Normal
 SOCIAL HISTORY:

 Diet: Mixed
 Marital status: single
 Smoking: Nil
 Alcohol: Nil

 Past medical history :hypertension

 Past medication history :Telmisartan – 40mg

 Family history : Nil

 PHYSICAL EXAMINATIONS

PARAMETER D1 D2 D3 D4 D5

BP(mmHg) 130/80 130/90 150/90 130/80 120/80

75 78 82 78 78
PR(BPM)

22 22 22 22 22
RR(CPM)

TEMP N N N N N
 LAB PARAMETERS

PARAMETERS DAY 1 NORMAL RANGE

Hemoglobin 9.7g 12.0 to 15.5 g/dL
PCV 29% 36 to 46%
RBC 3.0 4.2 to 5.4 million /mcL
Platelets 2.4 1.5- 4.5 lakhs/mcL
WBC 7,300 4,000 - 11,000 cells/mcL
Neutropils 50% 40% to 60%
Lymphocytes 48% 20% to 40%
Eosinophils 02% 1% to 4%
Monocytes 00% 2% to 8%
Basophils 00% 0.5% to 1%
PT 17 sec 11 to 13.5 sec

PT INR 1.22 0.8 to 1.1

aPTT : test 40 sec 30 to 40 sec

Others:
P-ANCA – negative
C-ANCA – negative
24 hrs urinary proteins : 1820 mg/day
24hrs urinary volume : 2200 ml/day
Albumin in urine : ++
 DIAGNOSIS

Proteinuria under evaluation

PRES with seizures
Hypertension
 SOAP NOTE

Subjective:
Swelling of body and facial sufferness, back pain,
headache

Objective:

Low Hb, Low PCV, Low RBC,

Low Monocytes and Basophils,
High lymphocytes, High PT INR values
 CORE

Condition:
Swelling of body and facial sufferness, back pain, headache

 Outcome:
• To reduce signs and symptoms
• To reduce progression of disease
• Prevent complications(kidney failure)
• To improve quality of life
 REGIMEN
 First-line agents for PRES related hypertensive emergency
include intravenous nicardipine (5-15mg/h) and labetalol (2-
3mg/min). Nitroglycerine is not recommended in PRES
patients, as it has been suggested to aggravate the cerebral
edema but as the blood pressure is normal oral
antihypertensives should be given.
 short-term treatment with standard AEDs should be used to
treat seizures
 DRUG CHART
BRANDNAME DRUG NAME DOSE ROUTE FRE D1 D D
Q 2 3
T. LEVIPIL LEVETIRACETA 500 mg PO BD . . .
M
INJ.DYTOR TORSEMIDE 10mg IV BD . . .
T.TELMA TELMISARTAN 40mg PO OD . . .
T.CILACAR CILNIDIPINE 10 mg PO OD . . .
T.EIDO BIOTIN 300 mcg+ CALCIUM PO OD . . .
PANTOTHENATE 6 mg+ FOLIC
ACID 1500 mcg+
METHYLCOBALAMIN 500
mcg+ VITAMIN B2 3mg+
VITAMIN B3 25 mg+ VITAMIN
B6 10 mg+ VITAMIN C 50 mg
T.METOLAR - METOPROLOL 50mg PO OD X . .
XR
 EVALUATION

 Monitor renal function tests

 Monitor blood pressure alternatively

 Monitor CBC and urine albumin levels

 PRIME

 Pharmaceutical problems: Nil

 Risk Factors:

 Levetiracetam : decreased erythrocytes, pancytopenia,

thrombocytopenia
 Torsemide : polyuria
Interactions :
Metoprolol <> Torsemide: Using metoprolol and torsemide
together may lower your blood pressure and slow your heart
rate.

 Mismatch : nil

 Efficacy Related Problems: Nil

 PATIENT COUNSELLING
 Do not skip the dose, if uh skip the dose take as soon as possible,
if it is time for next dose then leave it.
 Do regular yoga or stress free exercises.
 Reduce protein diet such as pulses and nuts.
 Avoid stress.
 Do not withdraw from the drugs it may worsen the symptoms.
 Do not get worry about the torsemide having a side effect of
excessive urination.
 Avoid taking OTC drugs without discussing with the physician.
 Report of new or worsening depression , suicidal thoughts or
behaviour changes while taking levetiracetam drug.
 REFERENCES
 Kidney International reports
 Posterior Reversible Encephalopathy Syndrome (PRES): A
Case Report and Review of the Literature by practical
neurology
 Posterior Reversible Encephalopathy Syndrome: A Truly
Treatable Neurologic Illness artticle by NCBI
 Micromedex
THANK YOU