A 35 yr old male with c/o palpitations ,decresed appetite,burning sensation in chest since 5 months


 This the case i have seen 

A 35yr old man ,farmer by occupation came to hosipital with c/o palpitations,decreased appetite,burning sensation in chest since 5 months.tingling in both U/L and L/L

H/o vomitings and abdominal discomfort:10days ,non bilious,non projectile,ass with food particles .

H/o involuntary movements of B/L u/l and l/l with frothing from mouth ,uprolling of eyes today morning,lasting for 5 min with loc 

Post ictal  confusion present (10min)

No h/o involuntary passage of stools /micturation 

No h/o headache /blurring of vision /diplopia

No h/o sob /excess sweating /syncopal attacks 

No h/o pain abdomen/loose stools 

No h/o fever and cough 

No other conplaints 

H/o similar complaints of palpitations 4 yrs back 

Not a k/c/o htn,dm,asthma,epilesy,cad,tb

 


Personal history: normal appetite,non veg ,regular bowel movements ,normal  urine output

K/c/o alcoholic :10yrs 180ml/ day ,regular 540ml :5 months 

Smoker since 10 yrs :1 pack /day 


 General examination : 

Conscious,coherent,cooperative 

Moderately bulit and nourished 




No sign of pallor,icterus,cyanosis,clubbing,lymphadenopathy ,pedal oedema

Temp :afebrie, pr: 72/min

RR:20/min

Bp: 110/90mm/hg

Grbs :100 mg %


Systemic examination 

Cvs :s1s2 heard no murmurs

Rs:BAE + 

P/A : soft non tender ,no oraganomegaly

Cns : HMF intact 

Motor system : 

Power     Upper Limb             Lower Limb

Right          5/5                         5/5
Left             5/5                         5/5


Tone      Upper Limb             Lower Limb
Right          Normal               Normal 
Left             Normal              Normal 

Reflexes : Superficial Reflexes
                             Right     Left   
Corneal                  +            +
Conjunctival          +            + 
Abdominal             +            + 
Plantar                flexor     flexor

Deep Tendon Reflexes 
                                   Right      Left                                                Biceps                         3+           3+
       Triceps                 3+         3+
       Supinator             3+           3+
       Knee                     3+           3+
      Ankle                     3+           3+
    

Sensory system: 


Pain and temperature sensation-intact
Vibration sense-intact
Joint sense-intact 


Cranial nerve :intact 












Diagnosis : ALCOHOL WITHDRAWAL SEIZURES WITH ALCOHOL AND TOBACCO DEPENDENCE SYNDROME


Treatment:

1) INJ THIAMINE 2 AMP IN 100ML NS IV /TID

2) INJ OPTINEURON 1 AMP IN 100ML NS IV /OD 

3) TAB SODIUM VALPROATE 500 MG BD 

4) TAB DIAZEPAM 10 MG PO/TID

5) INJ PANTOP 40 MG IV/BD

6)INJ ZOFER 4MG IV /BD

7) IV FLUIDS 

 1 NS 50 ML /HR

1 RL 50 ML /HR

1 DNS 50 ML /HR


Comments

Post a Comment

Popular posts from this blog

A 45 year old male with complaints of left side loin pain radiating to groin since 8 days

Image
This is the case i have seen   A 45 year old male farmer by occupation chronic alcoholic and smoker presented with c/o left side loin pain radiating to groin :since 8 days Fever for 1 day associated with chills : 1 week back Vomitings and loose stools for 2 days - 5 days back Decreased urine output :5 days Pedal edema :4 days Patient was apparently assymptomatic 8 days back and then he developed left loin pain radiating to groin which subsided with medication .Then he developed fever associated with chills. Vomitings :3-4 episodes and loose stools : 5-6 episodes for 2 days associated with pain abdomen subsided on medication .Decreased urine output :5days and pedal edema (non pitting , painful extending upto knees) for 4 days .No h/o chest pain/sob/palpitations. No other complaints. Not a k/c/o DM /HTN/asthma /epilepsy /CAD/TB General examination: Pedal edema + upto knees Multiple ecchymotic patches + over both lower limbs Subconjunctival hemorrhage present Dry gangrene of tip
Read more

26 m btech with complaints of vomitings

Image
  26/M btech,completed 3yrs back non alcoholic and a non smoker , developed vomitings 4-5episodes on23rd December: yellow colored,non bilious,non blood stained contained foodparticles/water. Thenafter patient used to have vomitings every day 2-3episodes or at times multiple episodes for  one &half month i.e till feb 11th    After 15days of onset of vomitings i.e in January patient went to Suryapet hospital and there for the first time he was said to have high bp-170mmhg and brain imaging was done .Used anti hypertensive drugs for 10days and stopped On February 12th he presented with : 1-multiple episodes of vomitings a day before,2-he noticed decreased urine output since January  3- intermittent shortness of breath on walking for long distance 4-spasm of both calves since 5-6yrs monthly twice/thrice only night times due to which he used to get up from his sleep His creatinine was 15mg/dl On February 13th he was referred to NIMS  i/v/o renal biopsy.There his shortness of breath was
Read more