A 43 year old male with SEIZURES

Saturday, July 8, 2023

43 YEAR OLD MALE WITH SEIZURES

Introduction: Welcome to my blog! I am U.AKANKSHA a 4th year medical student.This is an online E-log Entry Blog to discuss, understand and review the clinical scenarios and data analysis of patients so as to develop my clinical competency in comprehending clinical cases, and providing evidence-based inputs.It also reflects patient centered online learning portfolio.

Note: The cases have been shared after taking consent from the patient/guardian. All names and other identifiers have been removed to secure and respect the privacy of the patient and the family.

Consent: An informed consent has been taken from the patient in the presence of the family attenders and other witnesses as well and the document has been conserved securely for future references. 

A 43 year old male was brought to the casualty with comlains of involuntary movements of body since today morning. 

HISTORY OF PRESENTING ILLNESS: 

The Patient was apparently asymptomatic 4 days back when he had a binge of alcohol . he lost consciousness at his workplace and was taken to the hospital. At the hospital, the correction fluids were given and the patient was sent home. Today morning he had 2 episodes of involuntary movement of body (tonic movements with stiffening of body) lasting 1-2 minutes and relieved on itself. 

His wife checked his grbs at home after this episode and it was found to be 60mg/dl after which he was rushed to the hospital. In the hospital the correction was done inspite of which involuntary movements continued. He was then brought to our hospital. 

No uprolling of eyes or loss of consciousness during the episodes.

No c/o vomitings, headache, frothing from mouth, deviation of mouth, tongue bite, post ictal confusion, involuntary micturition/defecation.

PAST HISTORY:

No similar complains in the past.

K/C/O DM-II since 5 years on insulin. He was diagnosed with DM-II Incidently during an episode of fever for which he was initially prescribed OHA'S. The patient used to skip taking his medication. Due non compliance and very high sugars he was then shifted to insulin. 

N/k/c/o HTN, CVA, CAD, Bronchial asthma, thyroid disorders. 

DAILY ROUTINE :

The patient works as an attender in a college.

He lives with his wife and three children.

He doesn't always follow his routine and go to the college.

He gets up in the morning and freshens up and has breakfast. After his family leaves for work/college, he either goes to college or goes out with his friends and drinks alcohol. 

He often skips meals  as he forgets about them while he is drinking alcohol. He often consumes food late at night when he is very hungry. 

The alcohol consumption has increased in the last 1 year. 

On enquiring about the reason of chronic alcoholism with his family, they say that they can't think of any triggers as such. 

PERSONAL HISTORY

Diet: mixed 

Appetite: lost

Sleep: adequate 

Bowel: regular 

Micturition: normal 

Addictions: drinks alcohol since 20 years, chews gutka since 1 year 

Allergies: nil

Family history: not significant

GENERAL EXAMINATION

Patient is examined in a well lit room after taking an informed consent. 

Patient is conscious and coherent. 

No signs of pallor, icterus, clubbing, cyanosis, generalized lymphadenopathy, pedal edema 

VITAL AT THE TIME OF ADMISSION: (09/07/23) 

Temp: 98F

Pulse: 114bpm

RR: 20cpm

Bp:100/80 mm of hg 

Spo2: 99% at RA

Grbs: 

Systemic examination:

CNS EXAMINATION: 

GCS: 15/15

The patient is conscious. 

Speech: normal

Cranial nerves: intact 

Seonsory system: normal 

Motor system: 

                       UL                       LL

Tone R INCREASED       INCREASED

          L INCREASED       INCREASED

POWER

          R      5/5                        5/5

          L       5/5                        5/5

REFLEXES           R                       L

BICEPS               2+                      2+

TRICEPS             1+                      1+

SUPINATOR        0                         0

KNEE                    0                         0

ANKLE                  0                         0

PLANTAR             E                         E

RESPIRATORY SYSTEM EXAMINATION 

-Bilateral air entry is present, normal vesicular breath sounds heard. 

CARDIO VASCULAR SYSTEM

S1 and S2 are heard. No murmurs are heard

ABDOMINAL EXAMINATION:

Soft, non-tender. 

No organomegaly

Bowel sounds are heard. 

INVESTIGATIONS:-

USG ABDOMEN

X-RAY CHEST

EEG 

ECG

PROVISIONAL DIAGNOSIS: SEIZURES UNDER EVALUATION SECONDARY TO ? HYPOGLYCEMIA ? TOXIN MEDIATED

INVESTIGATIONS: 

9/07/23

SERUM ELECTROLYTES: 

Na: 145

K: 3.2*

Cl: 99

Ca2+: 1.13

Mg2+: 2

Blood urea 20mg/dl

S. Creatinine: 1 mg/dl

RBS: 130MG/DL

LFT:

total billirubin : 0.98mg/dL

Direct bilirubin: 0.20 mg/dL

AST: 45 IU/L

ALT: 30IU/L

ALP: 301* IU/L

Total proteins: 7 gm/dL

Albumin: 4 gm/dL

A/G ratio: 1.25

Hemogram:

Hb: 10.9gm/dL*

Total count: 6,400cell/mm3*

N/L/E/M/B: 75/18*/2/5/0

PCV: 34.6 vol%*

MCV: 78.6fl*

MCH: 24.8pg*

MCHC: 31.5%

RDW-CV:18.2%*

RBC COUNT: 4.40 millions/mm3*

PLATELET COUNT: 1.92lakhs/mm3

Smear

RBC: normocytic normochromic 

TREATMENT GIVEN: 

INJ. LORAZEPAM 2CC IV/STASTAT

INJ. LEVIPIL 1GM IN 100ML NS IV/STAT

INJ. SODIUM VALPROATE 300MG IN 100ML NS IV/BD

INJ. HAI S/C ACCORDING TO GRBS

INJ. THIAMINE 1AMP IN 100ML NS IV/BD

SYP. POTCLOR 15ml IN 1 GLASS OF WATER

10/7/23

FBS: 192 MG/DL

PLBS: 294 MG/DL

HBA1c: 6.5%

HEMOGRAM

Hb: 9.7gm/dL*

Total count: 7,800 cell/mm3*

N/L/E/M/B: 70/20*/4/6/0

PCV: 30.2 vol%*

MCV: 70.8FL*

MCH: 25.1pg*

MCHC: 32.1%

RDW-CV:18.2%*

RBC COUNT: 3.8millions/mm3*

PLATELET COUNT: 2lakhs/mm3

Smear

RBC: normocytic normochromic 

SERUM ELECTROLYTES: 

Na: 139

K: 3.5*

Cl: 101

Ca2+: 1.24