32 M WITH GENERALIZED TONIC SEIZURES

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Here we discuss our individual patient problems through series of inputs from available global online community of experts with an aim to solve this patients clinical problems with collective current best evidence based inputs.

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I have been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency and to comprehend clinical data including history, clinical finding investigations and come up with a diagnosis and treatment plan.

CHIEF COMPLAINTS 

The patient was brought to casualty with loss of speech since morning 

HISTORY OF PRESENTING ILLNESS

Patient was apparently alright 10 days back and then he got loose stools 7-8 episodes per day, yellowish in color, mucoid, foul smelling, non blood tinged

C/o pain abdomen in the epigastrium twisting type, aggravated on taking food 

Today morning the patient had stiffening of bilateral UL and LL associated with up rolling of eyes in an unresponsive state, 2 episodes of involuntary micturition present, no tongue bite and drooling of saliva, his GRBS was low and after dextrose infusion the patient became responsive, no chest pain, palpitations, sob, vomitings 

PAST HISTORY

K/C/O DM 2 since 1 year on GLIMI m1 PO BD 10 days inj mixtard 20 U——-10U 

Known case of TB since 6 months using antiTB drugs irregularly 

Known case of acute pancreatitis 6 months ago 

Not a known case of CVA, CAD, thyroid disorders

Family history: father is a known case of TB 4 years ago

Personal history: consumes alcohol regularly 90 ml daily 

GENERAL EXAMINATION 

The patient was conscious, coherent, cooperative, 

Well oriented

He is malnourished and poorly built

Pallor present 

Clubbing present- stage 3 

Lymphadenopathy present: posterior cervical node palpable 

No cyanosis, edema 

Systemic examination; 

Cvs: s1, s2 heard, no murmurs 

Rs: bae +, reduced breath sounds on right side

Signs of volume loss present on the right side

P/A: soft, tenderness present in epigastrium 

Skin: Keloid present on the chest, post inflammatory hyper pigmented macules 3 months ago

Diagnosis: 

1) generalised tonic seizures secondary to hypoglycemia

2) hypokalemia under evaluation 

3) k/c/o tb since 6 months 

4) known case of dm 2 since 1 year

Treatment: 

- iv fluids NS, RL, DNS @ 100 ml per hour 

- iv fluids rl stat 

- inj. KCL 2 amp in 500 ml NS over 5 hours

- 

Pictures: 

Loss of volume can be seen by the hollowing of the clavicular fossa on the right side

Grade III clubbing can be seen

Drooping on the right shoulder 

Keloids are present from the childhood

Investigations:

BLOOD GROUP: O POSITIVE (+VE)

RBS: 78 MG/DL

BLOOD UREA: 11 MG/DL CUE:

ALBUMIN: +

SUGARS: NIL

PUS CELLS: 2-4 CELLS

HEMOGRAM :

HB: 10.1 GM/DL

TLC: 14500 CELLS/CUMM

PCV: 30.2 COL%

RBC COUNT: 4.0 MILLIONS/CUMM