Case Study: The Investigation of Drug Induced Liver Injury: A Case Study in In- patient of Internal Medicine Ward

Abstract

Adverse Drug Reactions (ADR's) caused by the use of drugs are still often founded in health services, especially those with the potential for Drug Induce Liver Injury. Therefore we need a measurement instrument to identify these events to prevent the hepatotoxic effects. In this case study, it was reported that a 22-year-old patient was admitted to a Surabaya city hospital in September 6, 2017 with complaints of nausea, vomiting, fever and decreased of appetite. On the laboratory examination found an increase in the total bilirubin value and Gamma Glutamyl Transferase. ALT significantly increased > 3x and ALP > 2x from the normal value. Based on the results of ultrasound and MRI, the impression of Gall Bladder Contracted and Cholecystitis Suspected were obtained with the conclusion that there was no obstruction of the biliary
system and the normal abdominal organs. From the results of an in-depth investigation, the patient said that he regularly consumes Carrol Superpil to reduce back pain. After the clinical pharmacy assessment for the first Patient was DILI with a RUCAM score of 7 (probable DILI) due to the use of Carrol Superpil as well as the presence of Drug Related Problems in the patient, namely as Ceftriaxone which prescribed during the hospitalization which could affect ALT/ALP, it is recommended to replace antibiotics with Cefotaxime 3x1 gr.