1. VSD
Case Presentation
By:
Mohammed Adel
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2. Content
• Case overall view
• Problems list
• Labs & clinical findings
• Diagnosis
• Pharmacotherapeutic management
• Recommendations to be reported
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3. Case overall view
A.Z. is a 4month old, 6Kgs male infant admitted with cough, fever and
difficulty of breath. Upon examination he is found cyanosed and dyspneic. The
symptoms started 2 wks ago and the parents were referred to the hospital by
external physician.
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4. Problem list
• Fever
• Dyspnea
• Grunting
• Chest infection
• Cyanosis
• Mild jaundice
• Decreased feeding
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5. Labs & clinical findings
• Na+ 141mmol/L
• K+ 5.06mmol/L
• SCr 0.6mg/dL
• Urea 32 mg/dL
• Alb. 3.9 g/dL
• PT 14.9 Sec
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• PTT 46 Sec.
• INR 1.45
• ALT 18 IU/L
• AST 38 IU/L
• Bili. T. 0.6 mg/dL
• Hgb 10.7g/dL
• PLT 388×103/mm3
• WBC 10.6× 103/mm3

6. Labs & clinical findings
• Temp. 39°C
• BP 90/70 mmHg
• HR 140Bpm
• Tachypnea
• Pan systolic murmur
• Pneumonia patches on X-ray
• Large tender liver
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7. Labs & clinical findings
• Echo revealed
• VSD 5.3 mm
• Dilated LV
• Severe TR
• PHTN 45 mmHg
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8. Diagnosis
The patient suffers VSD complicated with acute episode of
heart failure and pneumonia
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9. Pharmacotherapeutic management
• Cefepime 1gm diluted in 10 ml NS then
3ml IV q12hrs
• Amikin 500mg diluted in 5ml N.S then
administer IV 45” q12 hrs
• Lasix 4mg IV Q6hrs
• Calcium gluconate 6ml+ 10ml D5W
q8hrs
• Capoten® 6.25mg tablet1X3
• Vit.K injection as .5amp d Q24hrs
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• Temporal syrup 2ml 1X4
• .5ml farcoline+ .5ml atrovent+ 2ml
N.S nebulizer Q4hrs
• 1 ml dopamine +7ml dobutamine on
100 ml NS <rate 7dps/min
• Lanoxin syrup 45” Q12hrs
• Potassium syrup 2ml q7hrs

10. Recommendations to be reported
Drug interactions:
Calcium salts decrease the effect of dobutamine
Good reliability
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11. Recommendations to be reported
Precautions & Monitoring :
Captopril / furosemide
• Monitoring K level
Lanoxin /furosemide/ Ca gluconate
• ECG for arrhythmia
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12. Recommendations to be reported
Pharmacotherapeutic intervention required:
Amikin dose should be switched to 30mg Q8hrs (5-7mg/kg/dose Q8hrs)
Lanoxin dose should be adjusted to 60mcg/day (10-15 Mcg/Kg)
Lasix dose sould be increased to 6mg/ dose intermittent IV doses
(1mg/Kg/dose)
Capoten dose should be decreased to 2mg Q8hrs (.3-.5mg/Kg/dose
Q8hrs)
Consider Hemoglobin correction
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13. Thank You
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