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Uploaded byDr. Ajita Sadhukhan
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9. a case study on uti and iron deficiency anaemia

The case study details a 19-year-old female patient diagnosed with urinary tract infection (UTI) and iron deficiency anemia after presenting with abdominal pain, fever, headache, and weakness. Laboratory findings indicated low hemoglobin and red blood cell counts, as well as signs of infection. Treatment included intravenous antibiotics, fever management, iron supplementation, and dietary modifications, with the patient discharged after six days.

Health & Medicine◦
Related topics:
Urinary Tract Infection•
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A Case Study on UTI with Iron Deficiency Anaemia - Ajita Sadhukhan - Pharm D. 4th year - Roll No. : 1 - Enrolment No. : 150821207001 3/26/2020 1
Patient Demographics: • IPD No.: 18011675 • OPD No.: 18100453 • Age: 19 years • Sex: Female • Department: Female Medicine Ward • Unit: 2 • Date of Admission: 29.06.18 • Date of Discharge: 04.07.18 3/26/2020 2
Reason for admission: • C/O: – abdominal pain (epigastric pain) - fever all since 2 days - headache - weakness • CMP- 2nd day • Past History: NAD • Family History : NAD • Personal History: - appetite: normal - Bowel habit: regular - Addiction: none - Sleep: sound • ALLERGIES : NKA3/26/2020 3
OBJECTIVES: • General Examination: - Built: average - Nutrition: average - Clubbing: not seen - Jaundice: not seen - Pallor: ++ - Bowel habits: regular - Bladder habits: normal - Oedema: not seen - Skin, hair, nails: NAD - Tongue: pale - Eyes: pale - Lymphnodes: not palpable - Temperature: normal - Pulse: 86/min - B.P.: 110/70 mm Hg - Respiration: normal • Systemic Examination: - R.S.: AEBE clear - C.V.S.: NAD - C.N.S.: conscious, oriented - P/A: soft - G.U.S.: adequate UOP 3/26/2020 4
Lab. Investigation reports [first day] 3/26/2020 5 LABORATORY PARAMETERS OBSERVED VALUE NORMAL RANGE UNIT Hb 7.5 12.5-16 g/dL WBC 16850 4000-10500 /mcgL Neutrophils 82 50-70 % Eosinophils 01 0-7 % Lymphocytes 12 20-40 % Monocytes 05 <10 % Basophils 00 <1 % RBC 3.88 4.20-5.40 Millions/mcgL MCH 19.3 27-31 pg Platelets 247000 1.5-4.5*10^5 /mcgL MCV 64.4 78-100 fL Hematocrit (PCV) 25.0 37-47 % MCHC 30.0 32-36 g/dL RDW-CV 18.0 11-14.6 %
Contd… • PS for MP: malarial parasite not seen • Urine analysis: - Colour: reddish - Appearance: turbid - Reaction: 6.5 - Specific gravity: 1.015 • Chemical examination: - Protein: 2+ - Blood: 3+ • Microscopic examination: - RBC: plenty/HPF (0-10/HPF) - Epithelial cells: 2-3/HPF (absent) • Radiology report: no significant abnormality detected3/26/2020 6
Assessment: • Provisional Diagnosis: Fever under investigation 3/26/2020 7
ASSESSMEN T Justification: • A 19 year old female patient was admitted to female medicine ward unit 2 with complaints of abdominal pain in the epigastric region, fever, headache and weakness since 2 days. • Based on lab investigations, patient was presented with: - Low Hb, Low RBC, Low MCV, Low PCV, Low MCHC, high RDW-CV levels → anaemia - High WBC, High neutrophil, Low lymphocyte levels → infection/ inflammation - Low MCH level → iron deficiency anaemia - Reddish urine → hematuria caused by UTI - Turbid urine → due to presence of epithelial cells in urine caused due to UTI • Hence, the patient was diagnosed with UTI with iron deficiency anaemia. Final Diagnosis: UTI with iron deficiency anaemia. 3/26/2020 8
GOALS OF TREATMENT: • For UTI: - to eradicate the invading microorganisms causing the infection - prevent complications or treat systemic consequences of infections - provide symptomatic relief to patients - Prevent the recurrence of infection - Prevent antimicrobial resistance - early treatment is recommended to reduce the risk of progression to pyelonephritis • For iron deficiency anaemia: - To treat anaemia or to fully replace iron stores 3/26/2020 9
Day 1: • c/o mild chills • Temp.: 102.6 F • P: 96/min • B.P.: 110/70 mm Hg • SPO2: 98% • R.S.: NAD • C.V.S.: NAD • Urine: passed • Stool : passed 3/26/2020 10 Adv.: -CBC, PSMP, Urine –R & M, USG (abd. & pelvis) -Inj. NS (100 ml) + 2 amp. Febrinil (paracetamol) IV stat over 30 mins -Solid diet (SD)
Day 1 Medication chart: 3/26/2020 11 DRUG DOSE ROUTE FREQUENCY INDICATIONS Inj. Ceftriaxone + 500 ml NS 1 g I.V. 1-0-1 To treat UTI Inj. Paracetamol 1 amp I.V. 1-1-1 Fever Inj. pantoprazole 40 mg I.V. BD Gastric disturbance Inj. DNS/RL 1 pint @ 80 ml/hr I.V. - To maintain electrolyte balance
Day 2 3/26/2020 12 • Fever spike at 10 a.m. • Temp.: 102 F • GC stable • B.P.: 110/70 mm Hg • P: 114/min • SPO2: 99% @ RA • Stool: not passed • Urine: passed • R.S.: NAD • C.V.S: NAD • C.N.S.: NAD • P/A: soft
Day 2 Medication chart 3/26/2020 13 DRUG DOSE ROUTE FREQUENCY INDICATIONS Inj. Ceftriaxone + 500 ml NS 1 g I.V. 1-0-1 To treat UTI Inj. Paracetamol 1 amp I.V. 1-1-1 Fever Inj. pantoprazole 40 mg I.V. BD Gastric disturbance Inj. DNS/RL 1 pint @ 80 ml/hr I.V. - To maintain electrolyte balance
Day 3 • T: normal • P: 82/min • B.P.: 90/60 mm Hg • SPO2: 99% • R.S.: NAD • C.V.S: NAD • C.N.S.: NAD • Urine: passed • Stool: passed • No fresh complaints • Continue same treatment3/26/2020 14
Day 3 Medication chart 3/26/2020 15 DRUG DOSE ROUTE FREQUENCY INDICATIONS Inj. Ceftriaxone + 500 ml NS 1 g I.V. 1-0-1 To treat UTI Inj. Paracetamol 1 amp I.V. 1-1-1 Fever Inj. pantoprazole 40 mg I.V. BD Gastric disturbance Inj. DNS/RL 1 pint @ 80 ml/hr I.V. - To maintain electrolyte balance
Day 4 3/26/2020 16 • B.P.: 110/70 mm Hg • P: 115/min • SPO2: 99% • Stool: passed • Urine: passed • R.S.: NAD • C.V.S: NAD • C.N.S.: NAD • No fresh complaints • Adv.: CBC, iron profile, sickling •Hb: 5.5 g/dL •Total WBC count: 7530/mcgL •Platelet: 189000/mcgL
Day 4 Medication chart 3/26/2020 17 DRUG DOSE ROUTE FREQUENCY INDICATIONS Inj. Ceftriaxone + 500 ml NS 1 g I.V. 1-0-1 To treat UTI Inj. Paracetamol 1 amp I.V. 1-1-1 Fever Inj. pantoprazole 40 mg I.V. BD Gastric disturbance Inj. DNS/RL 1 pint @ 80 ml/hr I.V. - To maintain electrolyte balance
Day 5 • T: 96.7 F • P: 117/min • B.P.: 100/60 mm Hg • SPO2: 96% • R.S.: NAD • C.V.S: NAD • C.N.S.: NAD • Urine: passed • Stool: passed • No fresh complaints 3/26/2020 18 • Adv.: - Inj. Febrinil (paracetamol) IV SOS - Tab. Pantop (pantoprazole) 40 mg BD PO - Tab. Tonofolic Z 1-0-1
Day 5 Medication chart 3/26/2020 19 DRUG DOSE ROUTE FREQUENCY INDICATIONS Inj. Paracetamol 1 amp I.V. SOS Fever Tab. pantoprazole 40 mg P.O. BD Gastric disturbance Tab. Ferrous fumarate + folic acid + zinc sulphate 325 mg + 500 mcg + 50 mg P.O. 1-0-1 Iron deficiency anaemia
Day 6 • Temp.: 95.2 F • P: 103/min • B.P.: 110/70 mm Hg • SPO2: 99% • R.S.: NAD • C.V.S.: NAD • C.N.S.: NAD • Urine: passed • Stool : passed 3/26/2020 20 Adv.: -Tab. Pantop (pantoprazole) 40 mg BD PO -Tab. Tonofolic Z 1-0-1 -Tab. MBSon SL (cyanocobalamine) 1-0-1 X-ray chest (PA) view → not done (patient could not afford it) Discharge patient, follow-up after 7 days
Discharge Medication chart • Follow up after 7 days 3/26/2020 21 DRUG DOSE ROUTE FREQUENCY INDICATIONS Tab. cyanocobalamine 1500 mcg P.O. 1-0-1 Anaemia Tab. pantoprazole 40 mg P.O. BD Gastric disturbance Tab. Ferrous fumarate + folic acid + zinc sulphate 325 mg + 500 mcg + 50 mg P.O. 1-0-1 Iron deficiency anaemia
Treatment: • Ceftriaxone is a 3rd generation cephalosporin beta lactam antibiotic. It’s a bactericidal antibacterial that inhibits bacterial wall synthesis of the actively dividing cells by binding to one or more penicillin binding proteins, thus inhibiting bacterial wall synthesis resulting in cell death. It is used to treat UTI. • Paracetamol, or acetaminophen, is a centrally acting analgesic and anti-pyretic with minimal anti-inflammatory properties. It relieves fever by inhibiting the formulation and release of prostaglandin in the CNS and by inhibiting the endogenous pyrogens at the hypothalamic thermoregulatory centre. It is prescribed to reduce fever. • Pantoprazole is a proton pump inhibitor. It accumulates in the acidic compartment of the parietal cells and is converted to an active form, a sulphonamide that binds to hydrogen-potassium-ATPase at the secretory surface of the gastric parietal cells. Inhibition of hydrogen-potassium-ATPase blocks the final step of gastric acid production, leading to inhibition of both basal and stimulated acid secretion. • Ferrous fumarate: Used as iron supplement to treat iron deficiency anaemia. • Folic acid: It is a nutritive agent used to treat anaemia. • Zinc sulphate: Used as a source of zinc as supplement. • Cyanocobalamine: used to treat low vitamin B 12. 3/26/2020 22
Monitoring Parameters: Disease Related: • UTI: • Urine analysis • USG, CT scan or MRI of urinary tract • Cytoscopy (recurrent UTIs) • IDA: • Full blood examination • Serum ferritin • Total iron binding capacity (TIBC) and transferrin saturation • Soluble transferrin receptor (sTfR) • Bone marrow examination • Monitored therapeutic trial of iron Drugs Related: • Ceftriaxone: RFT, white blood cell count, differential count. • Paracetamol: fever reduction • Pantoprazole: Se. Mg2+, Vitamin B12 • Ferrous fumarate + Folic acid + Zince sulphate: • Cyanocobalamin: Hematocrit, reticulocyte count, vitamin B12, folate, iron levels
Treatment: 3/26/2020 24
POINTS TO BE INTERVENED WITH THE DOCTOR • Drug-drug interaction: - Pantoprazole + ferrous fumarate → monitor closely (moderate) pantoprazole will decrease the level or effect of ferrous fumarate by increasing gastric pH. Applies to oral form of both agent. Use caution/monitor. - Ferrous fumarate + zinc sulphate → monitor closely (moderate) concurrent use of iron and zinc will decrease the level or effect of ferrous fumarate/zinc by increasing gastric pH. Applies to oral form of both agent. Use caution/monitor. Separate use of iron or zinc by at least 2 hours is recommended. • Serum ferritin not done. 3/26/2020 25
Patient Counselling: • About disease: • UTI: Urinary tract infections are the most commonly occurring bacterial infections especially in females of childbearing age. Approximately 60% females develop UTI in their lifetime. UTI is treatable and curable with proper medications and adherence to therapy. It has high morbidity and low mortality. • Iron deficiency anaemia: IDA is characterized by decreased levels of ferritin and serum iron, as well as decreased transferrin saturation. It can affect both length and quality of life if proper care is not taken. It results in decreased iron carrying capacity of blood.it can be cured easily with proper diet. 3/26/2020 26
• About medications: ▪ Pantoprazole: 40 mg orally once daily for up to 8 weeks or in two divided doses twice a day. The adverse effects include abnormal ECG, peripheral oedema, itching, rash, etc. ▪ Ferrous fumarate + folic acid + zinc sulphate: Take with or without food twice a day. ▪ Cyanocobalamine: Take twice a day after food. ▪ In cases of missed dose, take the dose as soon as possible. 3/26/2020 27
• Life Style Modifications: • Drink plenty of water and keep yourself hydrated. • Drink cranberry juice to prevent UTI. • Lactobacillus probiotics are also helpful in preventing UTIs in females. • Iron is best absorbed from meat, fish and poultry. • Ready to eat cereal (100% fortified) ¾ cup, instant plain oatmeal (fortified) 1 cup, wheat germ, broccoli, baked potato, raw tofu ½ cup, lentils ½ cup, pomegranate are some iron rich foods. • Orange juice and other ascorbic acid rich foods can be included in meals to increase iron absorption whereas milk and tea reduce its absorption and should be consumed in moderation. 3/26/2020 28
References: • Pharmacotherapy: A Pathophysiologic Approach, 9th edition, by Joseph T. Dipiro • Micromedex • Medscape • Mayoclinic.com • Australian Red Cross Blood Service 3/26/2020 29
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