PHARMACOTHERAPY REVIEW
Pharmacy Department, Wales Hospital
Ward: Pediatric Bed: 17
CASE 1: FEBRILE FIT
A.
Pin.1/13
ALLERGY: NKDA
DEMOGRAPHIC DATA
Name: QS
MRN : 719899
Age : 6 Years 7 Months
Gender : M Race : M Ht/Wt : 23.7 kg/119.5 cm
DOA : 7/11/22
Chief Complaint:
History of Present Illness:
Past Medical History:
Fitting
Fitting Episode
Jerky movements associated with bilateral UL and LL
Claimed 1 minute
Noted
drooling
of
saliva
History of admission at 1 year old age for
febrile fit secondary to acute pharyngitis
Fever x 1/7
Started around morning 6/11/22
Claimed other children had fever and URTI symptoms
Cough x 1/52
Caretaker gave cough medication bought from
pharmacy
Chesty cough
Past Medication History:
Review of System:
BP: 119/69
PR: 119
RBS: 5.5
RR: 20
T: 38.4
SpO2: 99%
N/A
Compliance Evaluation:
N/A
Social/
Family
History:
Smoking
Alcohol
Drug Abuse
Pregnant
-
Social History:
Immunized up to age
Poor social support
Child was previously abused by
his stepfather
Child and elder sister ran away
from home
Biological father and mother are
drug abusers
Currently staying at an
orphanage
Family History
No contact with biological
mother and father
Unsure of family history of
epilepsy
Diagnosis/Surgical Procedure:
Febrile fit secondary to viral infection
B.
LABORATORY INVESTIGATION
BUSE / Renal Profile
FBC
Date
Normal Range
Platelet
MCV
MCH
Neut
Lymph
ANC
4–11 x 109/L
11.5-15.5
g/100mL
150-400 x109/L
77-95 fL
27-32 pg
40-75%
20-45%
2.0-7.0 x109/L
Urea
Na+
K+
ClSCr
CrCl
Ca2+
Mg2+
PO4-
2.5-6.0 mmol/L
138-145 mmol/L
3.4-4.7 mmol/L
98-107 mmol/L
36-60 umol/L
105-150 ml/min
2.20-2.7 mmol/L
0.7-0.86 mmol/L
0.74-1.52 mmol/L
2.08
1.36
0.75
Albumin
T.Bilirubin
T.Protein
ALP
ALT
35 – 50 g/L
<20 umol/L
66 – 87 g/L
53 – 141 u/L
<32 u/L
32
3.6
71
241
20.2
PT
APTT
10-13.5 sec
26 – 42 sec
Coag.
Profil
e
LFT
32
TWBC
Hb
1
8/11
2
9/11
11.2
13.4
258
71.0
23.8
73.3
17.60
8.23
3.9
133
4.5
99
37
3.8
130
4.3
95
50
3
4
5
6
7
8
9
10
<1.5
CE
CK
LDH
AST
24 – 195 u/l
0 – 248 u/l
<37 u/l
ABG
pH
pCO2
pO2
HCO3
O2 sat
7.35-7.45
35-45mmHg
72-100mmHg
22-29mmol/L
90-95%
RBS
AST
CRP
Neutrophil
Lymphocyte
ANC
Cor.Ca
< 11 mmol/L
<5 mg/L
34.4
Input
Output
Balance
Date
(Sampling)
Date
(Result)
Source/Sample
9/11/22
Pending
Blood Culture
Microorganism
Sensitivity
Resistance
C&S
I/O
Others
INR
C.
WARD MEDICATION
Start
Date
Syrup Amoxicillin 500 mg TDS (25mg/kg)
9/11
Syrup Paracetamol 355 mg QID/ PRN
Syrup Dexamethasone 3.5 mg STAT
Syrup Paracetamol 355 mg STAT
7/11
Stop
Date
Indication/
Reason for Change
Bronchopneumonia
Reconciliation Note
S-Stopped / W-Withold/
D-Continue on Discharge
(+Duration)
D (4/7)
OTHER MEDICATIONS
ANTIBIOTICS
Drug/Regimen
D.
PHARMACEUTICAL CARE PLAN
Fever
D (1/52)
7/11
7/11
Viral Croup
S
9/11
9/11
Fever
S
Date
7/11
8/11
8/11
Pharmaceutical Care Issues
Unnecessary administration of
Syrup Paracetamol 355 mg to the
patient. There are certain times in
the ward where the patient does not
experience any fever or pain
however paracetamol is still
administered to the patient.
Patient has productive cough with
phlegm but no mucolytic is given to
dissolve the phlegm
The patient may have underlying Iron
Deficiency
Anemia,
however
insufficient lab tests are available to
support the diagnosis. Based on
Pediatric Protocol, in order to diagnose
Iron Deficiency Anemia in Pediatrics,
there should be low MCH and MCV
levels, low iron and serum ferritin and
high TIBC levels.
Pharmacist’s Recommendations / Plan
To discontinue the administration of
syrup paracetamol when the patient is
afebrile and not in pain
To prevent unnecessary
administration
of
paracetamol to the patient
To properly measure the patient’s
temperature
to
prevent
any
unnecessary administration of Syrup
Paracetamol
Administer Syrup Bromhexine (0.3
mg/kg) 7 mg TDS
To resolve the patient’s
cough and phlegm
Conduct an iron study to determine the
serum iron, serum ferritin and TIBC levels of
the patient
To treat the patient’s
underlying iron deficiency
anemia, if any.
If the iron study results show low serum iron
and ferritin and high TIBC together with low
MCV and MCH levels, treatment should be
initiated.
Treatment: Syrup FAC (Ferrous Ammonium
Citrate) + Syrup Folate
MCV: 71.0 fL
(77-95 fL)
MCH: 23.8 pG
(27-32 pg)
Pharmacist’s Sign & Stamp:
Reviewed by:
Outcome