A CASE PRESENTATION

ON
“Decompensated Liver Disease”
SUBMITTED BY
B Nandhini,
17GT10003,
PHARM D 6TH YEAR
SRI VENKATESWARA COLLEGE OF PHARMACY

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 DEFINITION:
Decompensated liver disease is also known as decompensated cirrhosis. It is a
chronic liver disease that’s commonly the result of hepatitis or Alcohol use.
Cirrhosis is the severe scarring of the liver seen at the terminal stages of
chronic liver disease.

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PATIENT DETAILS:

A 50 years Old male patient named Dhana was admitted in Government

Hospital, Chittoor with I.P No: 2022082259

CHIEF COMPLAINTS:
• Cough
• Abdominal Distension
• Hameotochezia

HISTORY OF PRESENT ILLNESS:

The patient has been suffering from the above mentioned complaint for
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PAST MEDICAL HISTORY:
K/C/O T2DM, SHTN for the past 15 years
PAST MEDICATION HISTORY
T.Metformin 500mg for the past 15 years
T.Telmisartan 40mg for the past 15 years
PERSONAL HISTORY:
• Mixed diet
• Smoker for the past 10 years
• Alcoholic for the past 10 years
• Sleep and appetite - Normal
• Bowel and Bladder – Normal 4
GENERAL EXAMINATION:
The patient was Conscious , coherent and oriented
PHYSICAL EXAMINATION:
• Pallor- Yes
• Icterus- Yes
• Cyanosis- no
• Clubbing- no
• Lymphadenopathy- no
• Odema-Yes

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VITALS:
DAY D1 D2 D3 D4 D5 D6

B.P.
120/100 130/100 110/90 120/80 120/80 130/90
(mm of Hg)
TEMP.
98.6 98.6 99.6 98.4 98.5 98.6
(°F)
P.R.
85 85 72 76 75 72
(bpm)
R.R.
16 17 19 21 20 20
(bpm)
SPo2
94 95 94 97 96 98
(%)

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SYSTEMIC EXAMINATION:
• CVS-S1,S2 ⊕ , No Murmurs
• CNS-NFND
• RS-NVBS
• P/A- Tenderness ⊕, Hepatomegaly

PROVISIONAL DIAGNOSIS:
? Decompensated Liver Disease

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LABORATORY INVESTIGATION:
TEST TEST VALUE NORMAL VALUE
RBS (mg/dl) 124 70-140 md/dl
Sr. Bil (Direct) 0.6 0-0.3mg/dl
Sr. Bil (Total) 1.5 0-1.0mg/dl
Serum creatine (mg/dl) 0.8 0.6-1.2mg/dl
Haemoglobin (gm/dl) 6.4 14-16 gm/dl
WBC (cu mm) 17590 4500-11000
RBC 2.02 4-6 million cells/cumm
PLT 2.2 1.5L-4.5L
Blood Urea 24 <40
SGPT 72 <40
SGOT 97 <40
S.Protein 1.8 6-8gm/l
S.Albumin 0.8 3.4-5.4gm/l
ALP 145 42-98
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SPECIAL INVESTIGATION:

ECG report revealed that Patient had manifested with

• Sinus Rhythm
• Boderline ECG

USG- ABD report revealed that the patient had manifested with

• Hepatomegaly with moderate Ascities

• Slight Spleenomegaly

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FINAL DIAGNOSIS:
• Based on the above findings the patient was diagnosed with

“Decompensated Liver Disease ”

GENERIC BRAND NAME INDICATION FREQUENCY ROA DOSE D1-D6
NAME
CEFOTAXIME TAXIM ANTIBIOTIC BD IV 1gm

FUROSEMIDE LASIX DIURETIC OD IV 40mg 
SPIRANOLACTONE ADLACTONE DIURETIC OD PO 25mg 

URSODEOXYCHOLIC URSODIOL ALD PROPHYLAXIS OD PO 300mg 

ACID
TELMISARTAN TELMA ANTI-HYPETENSIVE OD PO 40mg 

IRON SUCROSE I MAX-S IRON SUPPLEMENTS ALTERNATE DAYS IV 200mg 

AMBROXOL AMBRODIL MUCOLYTIC TID PO 5ml 

PANTOPRAZOLE PROTONIX GI PROPHYLAXIS BD PO 40mg 

METFORMIN GLYCOMET HYPOGLYCEMIC AGENT BD PO 500mg 

FERROUS FUMARATE/ LIVOGEN IRON SUPPLEMENTS OD PO 

FOLATE
THIAMINE AMINTOZ VITAMIN SUPPLEMENT BD PO 100mg 

Discharge Advice: WITH THE SAME MEDICATION IN CHART FOR 5 DAYS AND TO REVIEW IN OP 30DAYS 11
SOAP ANALYSIS:
• SUBJECTIVE FINDINGS: Cough ,Abdominal Distension ,
Hameotochezia

• OBJECTIVE FINDINGS: SGOT-72, SGPT-69, ALP-145, Hepatomegaly

• ASSESSMENT: Decompensated Liver Disease

• PLAN: Medical Management

 PRESCRIPTION ANALYSIS:
 Needing pharmacotherapy and not receiving It- Yes

Eg: 1.As the patient is suffering from portal hypertension indicated by hematochezia (4-6 times) and

ascities , the patient is needing a therapy

 Taking or receiving the wrong drug-NO

 Experiencing an adverse effect –YES

Eg: Iron deficiency Anemia due to long term use of Metformin

 Experiencing a drug-drug or drug-food interaction- YES

Eg. Furosemide+ Metformin = Furosemide will increase the level of Metformin and causes hypoglycemia

• Taking or receiving a drug for no valid indication-NO

Hence the prescription is found to be IRRATIONAL

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PHARMACIST INTERVENTION:
Metfomin should be replaced by other Oral Hypoglycemic
Agent like Pioglitazone as it causing a adverse effect and
interaction in patient

The patient should be recommended with Propranolol or

Isosorbide dinitrate in order to treat Portal hypertension
 PATIENT COUNSELLING:
Disease Information:
This is a late stage of scarring of the liver
Drug Information:
• Lasix was given to overcome the fluid accumulation
• Pantaprazole, should be taken ½ hour before food
• Don’t skip medication , Follow as per prescription
• Advised to not take OTC medication without proper indication and
guidance
Life Style Modification:
• Advised to eat low sodium diet , protein and thiamine rich foods
• Advised for Alcohol and Smoking Cessation 15
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