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


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