65 year old female with altered sensorium

 This is an online E-log book to discuss our patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patient's problems through series of inputs from available global online community of experts with an aim to solve those patient's clinical problems with collective current best evidence based inputs.



CASE PRESENTATION:


A 65 year old female, came with c/o unresponsiveness since 2 days.
Pt was apparently asymptomatic 5 days back ,then she developed pain in right hip and stopped going to work.she also had 1 episode of fever. 
She is unable to recognize her family members properly, complaining of some one is going to attack her.
She also had an episode of involuntary urination.
H/O 90 ml alcohol intake every day since 5 years


PAST HISTORY:

Not a k/c/o DM/HTN/TB/ASHTMA/EPILEPSY/CAD 
H/O Histerectomy 20 years back

Personal History :

Diet : mixed
Appetite : Normal 
Sleep : Adequate 
Bowel movements : Normal 
Bladder movements : Normal


On Examination :

Patient is unresponsive 
Pallor -Absent
Icterus -Absent
Cyanosis -Absent
Clubbing -Absent
Lymphadenopathy -Absent
Edema -Absent

















Vitals at presentation 

Bp-180/100mmhg
PR-90 bpm
Cvs- s1 s2+
RS- BAE+
CNS-
Pupils at presentation
Bilateral constricted non reactive to light
GCS At admission 
E2V1M4
GCS today
E1V1M5
Pupils- (today)right reactive to light.

Power:   Couldn’t be elicited 
Moving all four limbs to pain
TONE

U/L.      Normal.   Normal
L/L.      Normal.     Normal

Reflexes: Right.     Left. 

Biceps.      ++.          ++

Triceps.    ++.          ++

Supinator ++.          -

Knee.         ++.         ++

Ankle        -               -
Bilateral plantars flexors 

Today's vitals
BP-140/80mmhg 
PR-67bpm

Treatment:
1.RT feed - 100ml milk 4th hrly,100 ml water 2nd hrly
2.INJ.LEVIPIL 500 MG /IV/BD
3.INJ.DEXAMETHQSONE 8 MG /IV/TID
4.IVF-NS@100ML/HR


INVESTIGATIONS 



















PROVISIONAL DIAGNOSIS:ALTERED SENSORIUM SECONDARY TO ? MENINGOENCEPHALITIS 

Treatment on 19/11/22
1.RT feed - 100ml milk 4th hrly,100 ml water 2nd hrly
2.INJ.LEVIPIL 500 MG /IV/BD
3.INJ.DEXAMETHQSONE 8 MG /IV/TID
4.IVF-NS@100ML/HR

Treatment on 20/11/22
1.RT feed - 100ml milk 4th hrly,100 ml water 2nd hrly
2.INJ.LEVIPIL 500 MG /IV/BD
3.INJ.DEXAMETHQSONE 8 MG /IV/TID
4.IVF-NS@100ML/HR

On 21/11/22

1.RT feed - 100ml milk 4th hrly,100 ml water 2nd hrly
2.INJ.DEXAMETHASONE 8 MG /IV/TID
3.IVF-NS@100ML/HR
4.TAB.RIFAMPICIN 600 MG
5.TAB.PYRAZINAMIDE 1200 MG
6.TAB.ISONIAZID 300 MG
7.TAB.ETHAMBUTOL 1100 MG RT/OD


On 22/11/22

1.RT feed - 100ml milk 4th hrly,100 ml water 2nd hrly
2.INJ.DEXAMETHASONE 8 MG /IV/TID
3.IVF-NS@100ML/HR
4.TAB.RIFAMPICIN 600 MG
5.TAB.PYRAZINAMIDE 1200 MG
6.TAB.ISONIAZID 300 MG
7.TAB.ETHAMBUTOL 1100 MG RT/


On 23/11/22

1.RT feed - 100ml milk 4th hrly,100 ml water 2nd hrly
2.INJ.DEXAMETHASONE 8 MG /IV/TID
3.IVF-NS@100ML/HR
4.TAB.RIFAMPICIN 600 MG
5.TAB.PYRAZINAMIDE 1200 MG
6.TAB.ISONIAZID 300 MG
7.TAB.ETHAMBUTOL 1100 MG RT/


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