32 YR OLD MALE WITH INVOLUNTARY MOVEMENTS

202410956 M Nagu
CASE HISTORY AND CLINICAL FINDINGS
PATIENT WAS BROUGHT TO CASUALITY WITH H/O INVOLUNTARY MOVEMENTS MULTIPLE
TIMES SINCE 2 DAYS
HOPI
PATIENT WAS APPRENTLY ASYMPTOMATIC 2 DAYS AGO THEN HE DEVELOPED ONE
EPISODE OF SEIZURE LIKE ACTIVITY AT 11 PM ON 6/3/24 .ONE EPISODE AT 9PM ON 7/3/24,4
EPISODES WITH 5 MINUTES INTERVAL AT 12 AM ON 7/3/24 EACH EPISODE LASTING FOR 5-
10 MINUTES WITH INVOLUNTARY MOVEMENTS OF ALL FOUR LIMBS.FROATHING FROM
MOUTH PRESENT,UPROLLING OF EYEBALLS PRESENT
TONGUE BITE ABSENT
INVOLUNTARY MICTURITION,DEFEACATION ABSENT
H/O VOMITING FOR 2 DAYS ,3 EPISODES PER DAY,FOOD AS CONTENT,NON BILIOUS
NO H/O HEAD TRAUMA,FEVER,LOOSE STOOLS
PAST HISTORY;
K/C/O DM SINCE 6 YEARS ON REGULAR MEDICATION ON TAB.GLICLAZIDE 60MG PO/OD
N/K/C/O HTN,EPILEPSY,CAD,CVA,ASTHAMA,THYROID
GENERAL EXAMINATION
PT IS C/C/C
PR - 104BPM
BP - 180 / 100 MMHG
RR - 20 CPM
TEMP - 98 F
GRBS - 312 MG /DL
CVS - S1 S2 PRESENT
RS - BAE PRESENT , NVBS
P/A - SOFT , NON TENDER
PSYCHIATRY REFERRAL ON 8/3/24 I/V/O ALCOHOL WITHDRAWL
ADVICED -
PT AND ATTENDERS PSYCHOEDUCATED
PT COUNSELLED
INJ LORAZEPAM 1/2 AMP IM /SOS IF PT IRRITABLE OR SLEEPLESS
RELAXATION AND DIVERSION TECHNIQUES EXPLAINED
CNS - NO FND
OPTHALMOLOGY REFFERAL ON 9/3/24 I/V/O RETINOPATHY
RE ? MODERATE TO SEVERE DIABETIC RETINOPATHIC CHANGES
LE ?PROLIFERATIVE DIABETIC RETINOPATHY
ADVISED
B SCAN BUT PT NOT WILLING
INVESTIGATION
SERUM ELECTROLYTES (Na, K, C l) 08-03-2024 06:07:AMSODIUM 132 mEq/L 145-136
mEq/LPOTASSIUM 4.5 mEq/L 5.1-3.5 mEq/LCHLORIDE 105 mEq/L 98-107 mEq/L
ABG 08-03-2024 06:07:AMPH 7.37PCO2 37.8PO2 115HCO3 21.7St.HCO3 22.3BEB -2.5BEecf -
2.7TCO2 40.6O2 Sat 95.5O2 Count 24.4BLOOD UREA 08-03-2024 07:06:AM 34 mg/dl 42-12 mg/dl
SERUM CREATININE 08-03-2024 07:06:AM 1.1 mg/dl 1.3-0.9 mg/dlLIVER FUNCTION TEST (LFT)
08-03-2024 07:06:AMTotal Bilurubin 0.60 mg/dl 1-0 mg/dlDirect Bilurubin 0.19 mg/dl 0.2-0.0
mg/dlSGOT(AST) 18 IU/L 35-0 IU/LSGPT(ALT) 20 IU/L 45-0 IU/LALKALINE PHOSPHATASE 220
IU/L 128-53 IU/LTOTAL PROTEINS 7.1 gm/dl 8.3-6.4 gm/dlALBUMIN 3.9 gm/dl 5.2-3.5 gm/dlA/G
RATIO 1.24
HBsAg-RAPID 08-03-2024 07:06:AM NegativeAnti HCV Antibodies - RAPID 08-03-2024 07:06:AM
Non Reactive
POST LUNCH BLOOD SUGAR 08-03-2024 07:07:AM 408 mg/dl 140-0 mg/dlSERUM
ELECTROLYTES (Na, K, C l) 09-03-2024 08:00:AMSODIUM 136 mEq/L 145-136
mEq/LPOTASSIUM 3.9 mEq/L 5.1-3.5 mEq/LCHLORIDE 101 mEq/L 98-107 mEq/L
URINE FOR KETONE BODIES -NEGATIVE
CBP[8/3/2024]
HB - 15.4
TC - 15,000
RBC - 5.15
PLT - 1.56
CBP[12/3/2024]
HB -14.4
TC-10,900
PLT - 1.75
SPOT UPCR -1.88
24 HR URINE PROTEIN-660MG/DAY
24 HR URINE CREATININE- 0.79 G/DAY
RATIO- 0.83
T3- 0.83ng/ml
T4-12.09mcg/dl
TSH-1.01micro iu/ml
LIPID PROFILE
TOTAL CHOLESTEROL- 274
TRIGLYCERIDES 293 MG/DL
HDL 59.6 MG/DL
LDL 140 MG/DL
VLDL 58.6 MG/DL
2D ECHO
IMPRESSION -
EF - 60%
TRIVIAL MR +/TR+ , NO PAH
NO RWMA , CONCENTRIC LVH +
GOOD LV SYSTOLIC FUNCTION
GRADE 1 DIASTOLIC DYSFUNCTION
IVC 1.0CMS ,COLLAPSING
NO PE / CLOTS
USG ON 9/3 /24
IMPRESSION - GRADE 1 FATTY LIVER
MRI BRAIN - NO ABNORMALITY DETECTED
DIAGNOSIS
GTCS SECONDARY TO HYPERTENSIVE POSTERIOR REVERSIBLE ENCEPHALOPATHY
SYNDROME WITH HYPERTENSIVE URGENCY ALSO POSSIBLY ALCOHOL WITHDRAWL
DIABETES MELLITUS SINCE 6 YRS WITH DIABETIC NEPHROPATHY AND PROLIFERATIVE
DIABETIC RETINOPATHY
DENOVO HYPERTENSION [RESISTANT HYPERTENSION]
TREATMENT GIVEN
INJ .LEVIPIL 500 MG IV BD
INJ . THIAMINE 200 MG IN 100 ML NS IV TID
INJ.HAI S/C TID
INJ NPH S/C BD
INJ LABETOLOL 10MG/HR TAPERED ACC TO BP
T NICARDIA 20MG PO TID
T LABETOLOL 100MG PO SOS
T.TELMA 40 MG PO OD
T LASIX 40MG PO BD
T OLKEM TRIO [CILNIDIPINE 10MG +CHLORTHALIDONE 12.5MG+ OLMESARTAN 40MG]PO OD
ADVICE AT DISCHARGE
T.TELMA 40 MG PO /OD 8AM -X-X CONTINUE
T.PRAZOSIN 2.5 MG PO/TID 1-1-1 FOR 15 DAYS
T.ALDACTONE 25 MG PO /OD 1-X-1 FOR 15 DAYS
TAB AMLODIPINE 5MG PO HS X-X-1 FOR 15 DAYS
T.BENFOMET PLUS PO BD 1-0-1 FOR 1 MONTH
T.LEVIPIL 500 MG PO BD 1-0-1 FOR 1 MONTH
INJ. HUMAN ACTRAPID INSULIN S/C TID 16 U- 16U -16U
INJ . NPH S/C BD 14U -X-14U

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