70 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:

Patient came to casualty with chief complaints of 
Involuntary movements of B/L upper limbs and lower limbs since 1 day
Altered sensorium since 1 day

HOPI:
Pt was apparently asymptomatic 5 days ago and then she developed fever which is of high grade associated with chills and rigors and was diagnosed to have dengue and was treated for the same in a private hospital.Pt count 30k-35k-40k.
Pt also had involuntary movements of B/L upper limbs and lower limbs.Pt is agitated and decreased talking since morning 
No h/o tongue bite/uprolling of eye balls
No h/o Vomiting/involuntary micturition/Bowel movements 


Not a k/c/o DM ,HTN,TB,epilepsy and asthma 
Chronic smoker (chutta)since 30years,stopped 1 year back
Toddy drinker (on and off),stopped 20years back
H/O cataract surgery 1 year back

















At the time of admission 
Patient is in altered sensorium with her GCS being
E3V1M5(eye opening on calling,inappropriate sounds,localising pain)
Bp 160/100mmHg
PR 65bpm
Saturation 96%on room air(after 30 minutes after admission saturation 88% on room air,blood gas analysis was done and showed hypoxia and metabolic alkalosis 
RR-20 cpm
GRBS-157 mg/dl
Temp-97.5
Spo2-96 % on 6 lts O2
Neck stiffness was Present 
brudzinski sign was positive
Urea: 79mg/dL
Creat:1.6mg/dL
Na: 117mEq/L
K:3.5mEq/L
Cl:74mEq/L
Hb: 15.6gm/dL
TLC: 9700cells/cumm
Plt 78000cells/cumm
PT 24sec
INR 1.7
APTT 48sec
Urinary electrolytes 
UNa:191
Ucl:217
Uk:39.8
Serum osmolarity 251

O/E:
Pt is irritable
Temp-afebrile
BP- 130/80 mmHg 
PR-70 bpm
RR- 20 cpm
CVS-S1S2 +
RS-BAE +
P/A - soft,NT
CNS:
Pupils-
Right-sluggish reactive to light
Left-cataracr surgery- done reactive 
Neck rigidity +
Brudzinski' sign +
GCS-E2V2M5
CNS-
Power:   Couldn’t be elicited 
Moving all four limbs to pain

TONE

U/L.      Increased   Increased 
L/L.      Increased    Increased 

Tremors +
Involuntary movements +

Reflexes: Right.     Left. 

Biceps.      ++.          ++

Triceps.    +              ++

Supinator +                +

Knee.         ++.          +

Ankle        +                 +
Plantar-   M               M






















Provisional Diagnosis:
Altered sensorium secondary to? Hyponatremia? Meningoemceohalitis(viral dengue positive)
Metabolic alkalosis secondary to GI losses/hypokalemia

TREATMENT:

On 3/12/22

1)INJ. 3% NS @ 100 ml/hr
2)O2 supplementation to maintain saturation above 92
3)IVF @ 50 ml/hr
4)Ryles feed protein powder,milk 100 ml/4th hrly
    Water 100 ml 2nd hrly
5)INJ.VIT K 2amp
6)SYP POTCHLOR 10ml/RT/TID in 1 glass of water
7)INJ..DEXA 8 mg IV/TID
8)INJ.MONOCEF 2g IV/BD

On 4/12/22

1. 02 supplementation to maintain sat> 92%
2. Ryles feed-  milk with protein powder(100 ml 4th hrly)
- water 100 ml 2nd hrly
3.INJ.DEXA 8 MG/IV/TID(D2)
4.INJ.MONOCEF 2G/IV/BD(D2)
5.IVF NS@ 50 ML/HR IV CONTINUOUS INFUSION 
6.INJ.OPTINEURON 1AMP +  100 ML NS
7.VITALS ,GRBS MONITORING 4TH HRLY

On 5/12/22

1. 02 supplementation to maintain sat> 92%
2. Ryles feed-  milk with protein powder(100 ml 4th hrly)
- water 100 ml 2nd hrly
3.INJ.DEXA 8 MG/IV/TID(D2)
4.INJ.MONOCEF 2G/IV/BD(D2)
5.IVF NS@ 50 ML/HR IV CONTINUOUS INFUSION 
6.INJ.OPTINEURON 1AMP +  100 ML NS
7.Thrombophobe ointment 
8.VITALS ,GRBS MONITORING 4TH HRLY






Comments

Post a Comment

Popular posts from this blog

Medicine assignment

Image
Medicine assignment for the month of May 2021 Name: E.Laharika  Roll no: 29 I have been given the following cases to solve in an attmept to understand the topic of 'Patient clinical data analysis' to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and diagnosis and coem up with a treatment plan. This is the link of the questions asked regarding the cases:       http://medicinedepartment.blogspot.com/2021/05/online-blended-bimonthly-assignment.html?m=1 Below are my answers to the Medicine Assignment based on my comprehension of the cases.  FIRST CASE(NEUROLOGY) A 55 year old female patient, a resident of Miryalaguda and farmer by occupation  came to the hospital on 17/5/21  with the  chief complain ts   of  shortness of breath, pedal edema and facial puffiness  https://soumyanadella128eloggm.blogspot.com/2021/05/a-55-year-old-female-with-shortness-of.html 1) What is the evolution of the symptomatology in this
Read more

65 yr old male with fever,dry cough and generalised weakness

Image
  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 male came to casualty  with c/o Fever since 20 days  Cough since 10 days Generalised weakness since 10 days HOPI : Patient was apparently asymptomatic 20 days back then he developed fever which is  of high grade,intermittent,  associated with chills and no diurnal variation.  He  had Cough since 10 days which is associated with sputum which is white in colour He also had loss of appetite and generalised weakness No h/o nausea, vomiting  No h/o loose stools No h/o constipation  PAST HISTORY : K/C/O TB 1 year back(used medication for 6 months) Not a K/C/O DM/HTN Person
Read more

54 yr old male with dyselectrolytemia

Image
  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 54year old male ,came  with complaints of Hiccups since 4 days  Decreased Apetite since 4 days Generalised weakness since 4 days HOPI : Pt was apparently asymptomatic 7 years back and then had history of trauma to foot which was not healing went to hospital and was diagnosed as having diabetes initially on OHA and later changed to insulin (MIXTARD) Patient has similar complaints 8 months ago and 4 months ago and 1 month ago developed similar complaints of hiccups and was in altered sensorium and was diagnosed as altered sensorium secondary to dyselectrolytemia and CKD(Diabetic n
Read more