202305329

 

 


Case History and Clinical Findings COMPLAINTS OF GIDDINESS SINCE 1 DAY COMPLAINTS OF DOUBLE VISION SINCE MORNING

COMPLAINTS OF DIFFICULTY IN SWALLOWING SINCE MORNING COMPLAINTS OF WEAKNESS OF LEFT LOWER LIMB AND INABILITY TO WALK

 

HOPI:

PATIENT WAS APPARENTLY ASYMPTOMATIC TILL YESTERDAY THEN HE HAD 1 EPISODE OF VOMITING - FOOD PARTICLES AS CONTENT, NON PROJECTILE, NON BILIOUS, NON BLOOD STAINED

IN THE EVENING HE DEVELOPED GIDDINESS WHICH HE THOUGHT WAS HYPOGLYCEMIC EPISODE AND HAD A COOL DRINK.

 

THE GIDDINESS DIDN'T SUBSIDE SO HE WENT TO A LOCAL RMP AND FOUND TO BE HAVING SBP OF 90 MMHG AND HENCE FLUIDS WERE GIVEN AND SENT HOME.

AT AROUND 5 AM HE COULDN'T GET UP AND HE NOTICED WEAKNESS OF LEFT LOWER LIMB AND EXPERIENCED SEVERE GIDDINESS AND WAS TAKEN TO A LOCAL HOSPITAL WHERE MRI WAS DONE.

IT WAS FOUND THAT HE HAD ACUTE INFARCTS IN LEFT MEDULLA AND INFERIOR CEREEBLLAR HEMISPHERES.

HE ALSO DEVELOPED DIFFICULTY IN SWALLOWING (SOLIDS>LIQUIDS) AND DIPLOPIA AND WAS REFERRED HERE FOR FURTHER MANAGEMENT

 

PAST ILLNESS:

KNOWN CASE OF DIABETES MELLITUS TYPE II SINCE 10 YEARS (ON OHA)

OPERATED FOR ?APPENDICITIS 3 YEARS AGO AND COLOSTOMY WAS PLACED FOR 3 MONTHS AND WAS DIAGNOSED AS HBSAG POSITIVE AND NOT ON MEDICATION

NOT A KNOWN CASE OF HTN, ASTHMA, CAD, CVD

 

 

PERSONAL HISTORY:

DIET- MIXED

APPETITE- DECREASED

BOWEL AND BLADDER MOVEMENTS- REGULAR SLEEP- ADEQUATE

ADDICTIONS- ALCOHOLIC SINCE 3 YEARS (250ML BRANDY) CIGARETTE SMOKING SINCE 15 YEARS

KHAINI CHEWING SINCE 20 YEARS

 

 

ON EXAMINATION AT ADMISSION:

PATEINT IS CONSCIOUS, COHERENT, COOPERATIVE

NO PALLOR ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY, PEDAL EDEMA BP- 90/60MMHG

PR- 59BPM RR-18CPM

SPO2- 98%@RA GRBS- 283MG/DL CVS-S1 S2 +

 

RS- BAE+

PA- SOFT NON TENDER CNS-

GCS- E4V5M6

TONE OF BOTH UPPER AND LOWER LIMBS- NORMAL POWER

RT UPPER LIMB- 5/5 LT UPPERLIMB - 4/5 RT LOWERLIMB- 5/5 LT LOWERLIMB- 4/5 REFLEXES-

RIGHT LEFT BICEPS + ++ TRICEPS + ++ SUPINATOR ++ ++ KNEE + +

ANKLE - -

PLANTAR FLEXOR FLEXOR

 

 

GAIT- COULDN'T BE ELICITED

 

 

EXAMINATION AT DISCHARGE:

PATEINT IS CONSCIOUS, COHERENT, COOPERATIVE

NO PALLOR ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY, PEDAL EDEMA BP- 90/60MMHG

PR- 78BPM RR-17CPM

SPO2- 98%@RA GRBS- 249MG/DL CVS-S1 S2 +

RS- BAE+

PA- SOFT NON TENDER CNS-

GCS- E4V5M6

 

TONE OF BOTH UPPER AND LOWER LIMBS- NORMAL POWER

RT UPPER LIMB- 5/5 LT UPPERLIMB - 4/5 RT LOWERLIMB- 5/5 LT LOWERLIMB- 4/5 REFLEXES-

RIGHT LEFT BICEPS + ++ TRICEPS + ++ SUPINATOR - - KNEE - - ANKLE - -

PLANTAR FLEXION FLEXION

 

 

BRIEF COURSE IN HOSPITAL

PATIENT CAME WITH ABOVE COMPLAINTS WAS STABILISED BY GIVING T. ECOSPRIN 75MG,

T. CLOPITAB 75 MG, T. ATORVAS 10MG. ON INVESTIGATIONS HE WAS TESTED POSITIVE FOR HBSAG AND HIS OUTSIDE MRI SHOWED POSTERIOR CIRCULATION STROKE WITH ACUTE INFARCTS IN LEDT MEDULLA AND INFERIOR CEREBELLAR HEMISPHERE. ANTIPLATELET DRUGS AND STATINS WERE CONTINUED.

HE WAS REFERRED TO OPHTHALMOLOGIST ON 2/2/23 IN VIEW OF RAISED ICT AND ANISOCORIA AND ADVISE FOLLOWED. AS HE WAS KNOWN CASE OF DIABETES ANTI DIABETIC MEDICATION WAS CONTINUED. FOR GIDDINESS INJ PROMETHAZINE WAS ADMINISTERED.

WITH ADEQUATE TREATMENT PATIENT CONDITION IMPROVED AND IS BEING DISCHARGED IN HEMODYNAMICALLY STABLE CONDITION

Investigation HEMOGRAM ON 2/2/23 HB- 14.7GM/DL

TLC- 12,300 CELLS/CUMM

PLATELETS- 2.6 LAKHS/CUMM

IMPRESSION- NORMOCYTIC NORMOCHROMIC WITH LEUKOCYTOSIS

 

HEMOGRAM ON 4/2/23 HB- 15GM/DL

TLC- 10,200 CELLS/CUMM

PLT- 2.3 LAKHS/CUMM

IMP- NORMOCYTIC NORMOCHROMIC BLOOD PICTURE

 

 

HEMOGRAM ON 5/2/23 HB- 15.4GM/DL

TLC- 7400 CELLS/CUMM

PLT- 2.09 LAKHS/CUMM

IMP- NORMOCYTIC NORMOCHROMIC BLOOD PICTURE

 

 

HEMOGRAM ON 6/2/23 HB- 15GM/DL

TLC- 6100 CELLS/CUMM

PLT- 1.97 LAKHS/CUMM

IMP- NORMOCYTIC NORMOCHROMIC BLOOD PICTURE

 

 

LIPID PROFILE:

TOTAL CHOLESTEROL- 147MG/DL TRIGLYCERIDES- 180MG/DL

HDL- 38MG/DL LDL- 97MG/DL VLDL- 37.8 MG/DL

 

TROPONIN-I - 3834PG/ML

 

 

2D ECHO:

TRIVIAL TR NO MR/AR NO RWMA

TRIVIAL TR, NO MR/AR

NO AS/MS, SCLEROTIC AV

 

GOOD LV SYSTOLIC FUNCTION NO DIASTOLIC DYSFUNCTION NO PAH/PE

 

REVIEW 2D ECHO ON 4/2/23 NO RWMA

TRIVIAL TR, NO MR/AR

NO AS/MS, SCLEROTIC AV

EF=60, GOOD LV SYSTOLIC FUNCTION NO DIASTOLIC DYSFUNCTION

NO PAH/PE

 

 

USG- ABDOMEN GRADE II FATTY LIVER

Treatment Given(Enter only Generic Name)

RT FEEDS - 100ML MILK 4TH HOURLY 50ML WATER 2ND HOURLY T.ECOSPRIN 75MG RT OD

T. CLOPITAB 75MG RT OD

T. ATORVAS 10MG RT HS

T. BACLOFEN10MG RT OD

INJ PROMETHAZINE 25MG IM BD

INJ HUMAN ACTRAPID INSULIN SC TID ACC TO SLIDING SCALE INJ PAN 40MG IV OD

INJ ZOFER 4MG IV BD

Advice at Discharge

T.ECOSPRIN GOLD 75MG PO OD

T. PROMETHAZINE 25MG PO BD

T. GLIMI M1 PO OD

T. BACLOFEN 10MG PO OD

T. METFORMIN 500MG PO OD


Comments

Post a Comment

Popular posts from this blog

Image
27 year old male with pain abdomen  July 20, 2022   THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT  27 year old male painter by occupation was brought to causality with chief complaints of pain abdomen . HOPI  Patient was apparently alright 40 days back then he developed pain and burning sensation in the abdomen which is squeezing type and diffuse all over the abdomen relieved after passing stools . Stool - frequency: 3 times a day , Small amounts , non blood , normal in consistency, mucoid ,non foul smelling , non floating and yellow in color  Not associated with fever , vomitings ,headache, burning micturation, SOB , cold&cough, chills and rigors. P
Read more

202308047

  Case History and Clinical Findings C/O ABDOMINAL DISTENSION SINCE 1WEEK C/O DECREASED APETTITE SINCE 1 WEEK C/O DECREASED URINE OUTPUT SINCE AFTERNOON PT WAS APPARENTLY ALRIGHT 1MONTH BACK THEN HE DEVELOPED PAIN ABDOMEN ON AND OFF , THEN HE DEVELOPED ABDOMINAL DISTENSION , WHICH WAS INSIDIOUS IN ONSET , GRADUALLY PROGRESSIVE IN NATURE .   NO H/O FEVER , NAUSEA , VOMITING ,LOOSE STOOLOS , CONSTIPATION HE HAD LOSS OF APPETITE SINCE 1 WEEK AND DECREASE IN URINE OUTPUT SINCE AFTERNOON. NOT A K/C/O DM ,HTN , ASTHMA , TB , CAD , CVA , EPILEPSY OCCASIONAL ALCOHOL INTAKE , NO H/O SMOKING . GENERAL EXAMINATION : PT IS C/C/C, MODERATELY BUILT AND NOURISHED NO SIGNS OF PALLOR , ICTERUS , CYANOSIS , CLUBBING , LYMHADENOPATHY , EDEMA AFEBRILE PR -120BPM BP - 130/80 MMHG RR - 20CPM SPO2 - 98% AT ROOM AIR GRBS - 108MG% CVS - S1S2 HEARD , NO MURMURS CNS-HMF INTACT . NFND RS -BAE PRESENT , NO ADDED SOUNDS P/A - ABDOMEN DISTENDED , UMBILICUS CENTRAL ,
Read more

DISSERTATION TOPIC

 TITLE:- Managing sarcopenia and visceral fat driven vascular outcomes in patients with diabetes  Problem statement/ Background: "Although obesity-related type 2 diabetes mellitus (T2DM) and sarcopenia have been increasing worldwide, the associations among visceral fat accumulation, skeletal muscle indices (mass, strength, and quality) and vascular outcomes in T2DM remain poorly investigated." Quoted from reference 1 :  https://cardiab. biomedcentral.com/articles/10. 1186/s12933-018-0755-3 Even while it's easy to qualitatively spot individuals with reduced limb muscle mass and trunkal fat it is important to establish that improving limb muscle mass and reducing trunkal fat utilizing diet and exercise strategies would improve cardiovascular outcomes in patients with diabetes mellitus.  AIM: To improve vascular outcomes in patients at risk of diabetes evidenced by their increased visceral fat and reduced muscle mass and strength   OBJECTIVES : • To assess various clinical a
Read more