A 63 year old presented with weakness

This is an online E log book to discuss our patient's d-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. 


This E log book also reflects my patient-centered online learning portfolio and your valuable inputs on the comment box is welcome.

Here is a case i have seen:

 A 63  year old woman presented with a 1 week history of gradually progressive altered mental status. 


A cheerful lady, active in preparation for her grand daughter's marriage, the attendants - her daughter, an allied care staff here in KIMS and her son - reported that developed an unusual fatigue 1 week ago, when she felt weak and was unable to function independently. She then started vomiting whatever food she took. The attendants initially felt this was a benign issue and the patient herself too was too focused on the marriage. However, things only got worse and her vomiting became persistent and she became even more weak and fatigued and required help to attend nature calls too. One day before presentation, the patient almost moribund and couldn't function at all without help - she required help with eating, going to the bathroom and even getting up from bed. The daughter recalls that she had a fluctuating course in her mentation and reported a classical mild improvement in her sensorium often in the evenings. The attendants both noticed that she couldn't hold a proper conversation and even couldn't properly understand their words or questions. 


This morning, things took a turn for the worse, when she couldn't respond at all to their repeated concerned advances. She was brought to the hospital in this state. The attendants can't recall any history of urinary incontinence or involuntary movements of her limbs, they deny a history of fever, headache or photophobia, they deny any focal weakness or any illicit substance use. 


The attendants deny any significant past medical history, except for hypertension for 15 years, for which she has been taking Tab TELMISARTAN 40mg + HYDROCHLOROTHIAZIDE 12.5mg for more than 10 years now. She adheres well to a salt restricted diet and takes her meds on time. 

Personal history: 

Appetite: lost

Bowels: constipation since 3 days

Bladder- normal micturition

Family history:

No history of DM, HTN CAD, CVA, asthma in the family

General examination: patient is conscious, coherent, cooperative 

No pallor, icterus, cyanosis,clubbing,lymphadenopathy, edema.

Vitals:

Temperature: 98.9F

Pulse: 82bpm

Respiratory rate: 19cpm

Bp: 150/70mm hg

Spo2: 98% at RA

GRBS: 87 mg%

Systemic examination: 

Cvs: S1 S2 heard, no additional sounds or murmurs.

Rs:Bilateral air entry present, NVBS

Per Abdomen: soft,non tender,non palpable

Cns:NAD

INVESTIGATIONS:






















Treatment:

Day 0 

Bp charting 2nd hourly

Sr.Sodium 4th hourly

GRBS charting 2nd hourly

Monitor urine output 2nd hourly

IVF -3% NaCl infusion @25ml/hr

Inj pantoprazole 40 mg iv od 

Inj zofer 4 mg iv tid

Absolute free water restriction

.

Day 1:

IVF 3% Na Cl @25 ml/hr

Inj Pantop 40 mg iv od 

Inj zofer 4 mg iv tid

BP,PR MONITORING 

GRBS monitoring 4th hourly

Serum Sodium every 6th hourly

Fluid restriction 

Allow oral soft diet

Tab MVT od

Stop all other oral medications


Day 2:

IVF 3% Na Cl @25 ml/hr

Inj Pantop 40 mg iv od 

Inj zofer 4 mg iv tid

BP,PR monitoring 

GRBS monitoring tid

Fluid restriction 

Allow oral soft diet

Tab MVT od

Syp Lactulose 10ml/tid


Day 3:

Fluid restriction 

Inj Pantop 40 mg iv od 

Inj zofer 4 mg iv tid

BP,PR monitoring 

GRBS monitoring tid

Fluid restriction 

Allow oral soft diet

Tab MVT od

Syp Lactulose 10ml/tid



Day4:

Fluid restriction 

Tab.pantop 40 mg iv od

Inj zofer 4 mg iv bd

Syp lactulose 10 ml/tid

Tab MVT po od 

BP,PR monitoring 

GRBS monitoring tid

Inj Optineuron 1 amp in 100 ml NS IV OD

Syp Aristozyme 10 ml/tid




Comments

Post a Comment

Popular posts from this blog

A 74 year old female presented with weakness

Image
  Patient was apparently asymptomatic 10 years ago then she had met with RTA and had history of left forearm fracture , from then onwards she had ℅ weakness of left upper limb Head injury unknown  Then 10 days back she had H/o fall while going to washroom,unconsciously  ℅ weakness of right upper limb and lower limb and deviation of mouth to left side She also had ℅ seizures at time of fall She also had similar episodes 7-8 times since then No ℅ head ache,nausea,vomiting She is able to recognise faces Decreased appetite,significant weight loss present No ℅ fever ,cold,cough Speech slurred No h/o Htn,dm,epilepsy,asthma,tb,cva,cad GCS-15/15 Tobacco chewer since 50 years Alcoholic occasional since 50 years  General Examintaion: Temperature:afebrile Pr:92bpm Bp:120/80mm hg SpO2:98 at room air Rr:18cpm Cvs:s1s2 heard  Rs:bae+,nvbs Per abdomen :soft ,non tender Cns:alert, Speech slurred Reflexes:                Biceps triceps supinator knee ankle Right.    ++.        ++.           ++.       +
Read more

BIMONTHLY INTERNAL ASSESSMENT

Image
  1) A 55 year old man with Recurrent Focal Seizures Detailed patient case report here: http://ushaindurthi.blogspot.com/2020/11/55-year-old-male-with-complaints-of.html 1. What is the problem representation of this patient and what could be the anatomical site of lesion ? A.55 Y M patient who is a mestri worker came with c/o inability to move his right upper limb and episodes of seizures.He is a chronic alcoholic and beedi smoker since 35 years. Lesions may be seen in left fronto parietal temporal and occipital lobes.mostly temporal region. 2. Why are subcortical internal capsular infarcts more common that cortical infarcts? A. small subcortical infarcts (RSSIs) mostly result from the occlusion of a single, small, brain artery due to intrinsic cerebral small-vessel disease (CSVD). Some RSSIs may be attributable to other causes such as cardiac embolism or large-artery disease, and their association with coexisting CSVD and vascular risk factors may vary with morphological magnetic reso
Read more