Case 21 85 F 10/2/25

Doa 10/2/25

Dod 17/2/25

Diagnosis

ALTERED SENSORIUMM SECONDARY TO ? NON CONVULSIVE SEIZURES ? STATUS

EPILEPTICUS ?ASEPTIC MENINGITIS

UTI (RESOLVED)

GRADE 2 BEDSORE

K/C/O T2DM SINCE 7 YEARS

K/C/O HYPERTENSION SINCE 5 YEARS

Case History and Clinical Findings

CHEIF COMPLAINTS OF LOSS OF COUNSCIOUSNESS 1 MONTH BACK

C/O SUDDEN ONSET ALTERED SENSORIUM SINCE 10 DAYS

C/O DIFFICULTY OF SPEECH SINCE 10 DAYS

HOPI;

PATIENT WAS APPARENTLY ASYMPTOMATIC 1 MONTH AGO AND THEN SHE DEVELOPED

SUDDEN ONSET LOSS OF COUNSCIOUSNESS, FOR BRIEF PERIOD, THEN SHE REGAINED

CONSCIOSNESS, FOLLOWING THAT PATIENT DEVELOPED ALTERED SENSORIUM A/W

IRRITABILITY. PATIENT WAS TAKEN TO A LOCAL HOSPITAL MFOR WHICH SHE WAS

ADMITTED AND TREATED FOR 5 DAYS. SHE IMPROVED DURING THE COURSE OF

TREATMENT AND WAS DISCHARGED FROM THAT LOCAL HOSPITAL. AFTER FEW DAYS OF

BEING DISCHARGED PATIENT DEVELOPED SUDDEN ONSET OF WEAKNESS, STARING GAZE

F/B FROTHING FROM MOUTH. SHE WAS INITIALLY TAKEN TO ANOTHER HOSPITAL WHERE

SHE WAS TREATED AS ASEPTIC MENINGITIS. PATIENT THEN CAME TO THIS HOSPITAL FOR

FURTHER EVALUATION AND TREATED.

PAST HISTORY-

K/C/O T2 DM SINCE 7 YEARS ON TAB. GLIMI M1

K/C/O HTN SINCE 5 YEARS TAB. TELMA 40

NO H/O FEVER, COLD, ALLERGIES,CHEST PAIN, PALPITATIONS, SWEATING, SOB,

ABDOMINAL PAIN, NAUSEA, VOMITING

N/K/C/O ,TB,EPILEPSY,ASTHMA,CVA,CAD

PERSONAL HISTORY

DIET-MIXED

SLEEP-ADEQUATE

APPETITE-NORMAL

BOWEL MOVEMENTS-- REGULAR

MICTURITION- NORMAL

GENERAL EXAMINATION

PT IS C/C/C

TEMP.AFEBRILE

PR 78 BPM

BP 130/90MMHG

RR 18CYCLES PER MIN

SPO2 98%

SYSTEMIC EXAMINATION:

CVS:S1 S2 HEARD , NO MURMURS

RS:BAE +

P/A:SOFT,NT, NO ORAGANOMEGALY

CNS

TONE RIGHT LEFT

UL N N

LL N N

POWER - CANNOT BE ELICITED

REFLEXES

B +1 +1

T - -

S - -

K - -

A - -

P E E

PUPILS - B/L MID DILATED REACTING

CONJUNCTIVAL REFLEXES - PRESENT

DOLLS EYE REFLEX- POSITIVE

Investigation

Name Value Range

Name Value RangeCOMPLETE URINE EXAMINATION (CUE) 10-02-2025 07:50:PMCOLOUR Pale

yellowAPPEARANCE ClearREACTION AcidicSP.GRAVITY 1.010ALBUMIN nil SUGAR NilBILE

SALTS NilBILE PIGMENTS NilPUS CELLS 4-5EPITHELIAL CELLS 2-3RED BLOOD CELLS

NilCRYSTALS NilCASTS NilAMORPHOUS DEPOSITS AbsentOTHERS Nil

HBsAg-RAPID 10-02-2025 07:50:PM NegativeAnti HCV Antibodies - RAPID 10-02-2025 07:50:PM

Non Reactive

RFT 10-02-2025 07:50:PMUREA 24 mg/dl 50-17 mg/dlCREATININE 1.8 mg/dl 1.2-0.6 mg/dlURIC

ACID 2.1 mmol/L 6-2.6 mmol/LCALCIUM 9.3 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 2.3 mg/dl 4.5-2.5

mg/dlSODIUM 138 mmol/L 145-136 mmol/LPOTASSIUM 3.4 mmol/L. 5.1-3.5 mmol/L.CHLORIDE

105 mmol/L 98-107 mmol/LLIVER FUNCTION TEST (LFT) 10-02-2025 07:50:PMTotal Bilurubin 0.82

mg/dl 1-0 mg/dlDirect Bilurubin 0.19 mg/dl 0.2-0.0 mg/dlSGOT(AST) 47 IU/L 31-0 IU/LSGPT(ALT) 25

IU/L 34-0 IU/LALKALINE PHOSPHATASE 378 IU/L 128-56 IU/LTOTAL PROTEINS 4.7 gm/dl 8.3-6.4

gm/dlALBUMIN 2.11 gm/dl 4.6-3.2 gm/dlA/G RATIO 0.81

ABG 10-02-2025 09:15:PMPH 7.37PCO2 43.5PO2 59.9HCO3 24.6St.HCO3 23.9BEB -0.2BEecf -

0.0TCO2 52.3O2 Sat 71.8O2 Count 9.3COMPLETE BLOOD PICTURE (CBP) 10-02-2025

10:53:PMHAEMOGLOBIN 10.3 gm/dl 15.0-12.0 gm/dlTOTAL COUNT 11500 cells/cumm 10000-4000

cells/cummNEUTROPHILS 58 % 80-40 %LYMPHOCYTES 25 % 40-20 %EOSINOPHILS 07 % 6-1

%MONOCYTES 10 % 10-2 %BASOPHILS 00 % 2-0 %PLATELET COUNT 5.25SMEAR Normocytic

normochromic with thrombocytosis

COMPLETE URINE EXAMINATION (CUE) 10-02-2025 10:53:PMCOLOUR Pale

yellowAPPEARANCE ClearREACTION AcidicSP.GRAVITY 1.010ALBUMIN +++SUGAR NilBILE

SALTS NilBILE PIGMENTS NilPUS CELLS 3-4EPITHELIAL CELLS 2-3RED BLOOD CELLS

NilCRYSTALS NilCASTS NilAMORPHOUS DEPOSITS AbsentOTHERS NilRFT 10-02-2025

10:53:PMUREA 22 mg/dl 50-17 mg/dlCREATININE 0.7 mg/dl 1.2-0.6 mg/dlURIC ACID 2.0 mmol/L 6-

2.6 mmol/LCALCIUM 9.5 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 2.3 mg/dl 4.5-2.5 mg/dlSODIUM 138

mmol/L 145-136 mmol/LPOTASSIUM 3.3 mmol/L. 5.1-3.5 mmol/L.CHLORIDE 104 mmol/L 98-107

mmol/L

LIVER FUNCTION TEST (LFT) 10-02-2025 10:53:PMTotal Bilurubin 0.91 mg/dl 1-0 mg/dlDirect

Bilurubin 0.18 mg/dl 0.2-0.0 mg/dlSGOT(AST) 49 IU/L 31-0 IU/LSGPT(ALT) 25 IU/L 34-0

IU/LALKALINE PHOSPHATASE 376 IU/L 128-56 IU/LTOTAL PROTEINS 4.7 gm/dl 8.3-6.4

gm/dlALBUMIN 2.18 gm/dl 4.6-3.2 gm/dlA/G RATIO 0.87HBsAg-RAPID 10-02-2025 10:53:PM

Negative

Anti HCV Antibodies - RAPID 10-02-2025 10:53:PM Non ReactiveCOMPLETE BLOOD PICTURE

(CBP) 12-02-2025 11:38:PMHAEMOGLOBIN 9.4 gm/dl 15.0-12.0 gm/dlTOTAL COUNT 9200

cells/cumm 10000-4000 cells/cummNEUTROPHILS 56 % 80-40 %LYMPHOCYTES 30 % 40-20

%EOSINOPHILS 05 % 6-1 %MONOCYTES 09 % 10-2 %BASOPHILS 00 % 2-0 %PLATELET

COUNT 4.24SMEAR Microcytic hypochromic anemia

COMPLETE URINE EXAMINATION (CUE) 12-02-2025 11:38:PMCOLOUR Pale

yellowAPPEARANCE CloudyREACTION AcidicSP.GRAVITY 1.010ALBUMIN ++++SUGAR NilBILE

SALTS NilBILE PIGMENTS NilPUS CELLS 4-6EPITHELIAL CELLS 2-4RED BLOOD CELLS 4-

6CRYSTALS NilCASTS NilAMORPHOUS DEPOSITS AbsentOTHERS Bacteria loaded , fungal

spores presentRFT 12-02-2025 11:38:PMUREA 23 mg/dl 50-17 mg/dlCREATININE 0.7 mg/dl 1.2-0.6

mg/dlURIC ACID 2.6 mmol/L 6-2.6 mmol/LCALCIUM 9.8 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 3.0

mg/dl 4.5-2.5 mg/dlSODIUM 135 mmol/L 145-136 mmol/LPOTASSIUM 3.4 mmol/L. 5.1-3.5

mmol/L.CHLORIDE 101 mmol/L 98-107 mmol/L

RFT 15-02-2025 11:12:PMUREA 41 mg/dl 50-17 mg/dlCREATININE 0.8 mg/dl 1.2-0.6 mg/dlURIC

ACID 2.4 mmol/L 6-2.6 mmol/LCALCIUM 9.9 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 2.8 mg/dl 4.5-2.5

mg/dlSODIUM 139 mmol/L 145-136 mmol/LPOTASSIUM 3.4 mmol/L. 5.1-3.5 mmol/L.CHLORIDE 99

mmol/L 98-107 mmol/L

MRI C SPINE IMPRESSION

C3 - C4, C4-C5, C5-C6 DISC OSTEOPHYTIC COMPLXES CAUSING MILD CENTRAL CANAL

STENOSIS.

CHRONIC WEDGE COMPRESSION FRACTURES OF L2 AND L4 VERTEBRAE - LIKELY

OSTEOPOROTIC

MRI BRAIN IMPRESSION

B/L CONFLUENT WHITE MATTER HYPERINTENSISTIES - FAZEKA'S GRADE III

FLUID IN RIGHT MIDDLE EAR AND MASTOID AIR CELLS

CSF CYTOLOGY

MICEROSCOPIC EXAMINATIO0N SHOWED FEW SCATTERD LUMPHOCYTES, MONOCYTES IN

THE CLEAR BACKGROUND.

NO E/O ATYPICAL CELLS

CSF

GRAM STAIN - NO INFLAMMATORY CELOLS, NO MICROORGANISMS SEEN

ZN STAIN - NO AFB SEEN

INDIAN INK STAIN - NEGATIVE FOR CRYPTOCOCCUS

2DECHO DONE ON 12/2/25

CONCENTRIC LVH+, NO RWMA

MILD AR,TRIVIAL MR, MILD TR WITH PAH

SCLEROTIC AV, NO AS/MS

GOOD DIASTOLIC DYSFUNCTION

NO PE, NO LV CLOT

IVC SIZE 0.6CMS COLLAPSING

RFT 17-02-2025 06:55:AMUREA 53 mg/dl 50-17 mg/dlCREATININE 1.1 mg/dl 1.2-0.6 mg/dlURIC

ACID 2.5 mmol/L 6-2.6 mmol/LCALCIUM 9.8 mg/dl 10.2-8.6 mg/dlPHOSPHOROUS 4.2 mg/dl 4.5-2.5

mg/dlSODIUM 137 mmol/L 145-136 mmol/LPOTASSIUM 4.4 mmol/L. 5.1-3.5 mmol/L.CHLORIDE 98

mmol/L 98-107 mmol/L

Treatment Given(Enter only Generic Name)

RT FEEDS ( 100ML WATER 2ND HRLY, 200ML MILK WITH PROTEIN POEDER 4TH HRLY )

INJ MONOCEF 1GM IV BD FOR 7 DAYS

INJ. OPTINERON 1AM IN 500 NS IV/OD

INJ. THIAMINE 200MG IN 100ML NS IV TID

INJ. HAI S/C TID ( ACC TO GRBS)

INJ. PAN 40MG IV/OD

INJ. LEVIPIL 500MG IV BD

TAB. STROCIT PLUS RT/BD

TAB. MET XL 25 MG RT/OD

TAB. CINOD 10MG RT/BD

NEOSPORIN POWDER L/A TID

PHYSIOTHERAPY OF B/L UL AND LL

POSITION CHANGE 2ND HRLY

Advice at Discharge

RT FEEDS ( 100ML WATER 2ND HRLY, 200ML MILK WITH PROTEIN POEDER 4TH HRLY )

TAB. GLIMI M1 RT/OD TO CONTINUE

TAB. THIAMINE 200MG RT/BD X 1O DAYS

TAB. PAN 40MG RT/OD X 10 DAYS

TAB. LEVIPIL 500MG RT BD TO CONTINUE

TAB. STROCIT PLUS RT/BD X 15 DAYS

TAB. MET XL 25 MG RT/OD TO CONTINUE

TAB. CINOD 10MG RT/BD TO CONTINUE

NEOSPORIN POWDER L/A TID

MUPUROCIN OINTMENT L/A OVER THE BEDSORE TID

PHYSIOTHERAPY OF B/L UL AND LL

POSITION CHANGE 2ND HRLY

Follow UP on 7/3/25

FBS 108 mg/dl

PLBS 147 mg/dl

HBA1c 6.5 %