Case 22. 64 male with involuntary movements

Doa 18/12/24

Dod 23/12/24

Diagnosis

GTCS SECONDARY TO OHA INDUCED HYPOGLYCEMIA (RESOLVED)

CKD SECONDARY TO POLYCYSTIC KIDNEYS

OLD CVA

K/C/O HTN

K/C/O TYPE 2 DM

Case History and Clinical Findings

PATIENT WAS BROUGHT TO CASUALTY IN CONFUSED STATE AFTER H/O INVOULNTARY

MOVEMENTS ,? TONIC CLONIC TYPE AT AROUND 4 PM WITH UPROLLING OF EYEBALLS ,NO

H/O TONGUE BITE ,FOPTHING FROM MOUTH,INVOLUNTRY MICTURITION,DEFECATION.

H/O GIDDINESS PRESENT,H/O 2 EPISODES OF VOMITING,FOOD AS CONTENT,H/O

SLURRING OF SPEECH PRESENT,POST ICTAL CONFUSION PRESENT

H/O NECKPAIN PRESENT,NO H/O HEADACHE.

H/O GENERALIZED WEAKNESS,LOSS OF APPETITE.

H/O PAIN IN PERIANAL REGION WITH H/O ULCER?PERIANAL FISTULA.

HOPI:

K/C/O HTN ON T.AMLODIPINE 5MG PO/OD

K/C/O TYPE 2 DM ON T.GLIMI.M PO/OD

N/K/C/O CAD,CVA,SEIZURES DISORDER,ASTHMA,TB

GENERAL EXAMINATION :

PATIENT IS C/C/C

NO PALLOR, ICTERUS, CYANOSIS, CLUBBING, LYMPHEDENOPATHY, EDEMA

BP: 200/100 MMHG

PR: 80 BPM

RR: 18 CPM

SPO2: 98%

GRBS- 45 mg/dL

APPETITE- NORMAL

BOWELS- REGULAR

MICTURITION- NORMAL

ADDICITIONS- REGULAR 90-180ML/DAY

COURSE IN HOSPITAL:

PATIENT WAS ADMITTED IN VIEW OF ABOVE SAID COMPLAINTS,AND ON FURTHER

EVALUATION PATIENT WAS DIAGNOSED AS GTCS SECONDARY TO OHA INDUCED

HYPOGLYCEMIA (RESOLVED) ,CKD SECONDARY TO POLYCYSTIC KIDNEYS ,OLD CVA ,K/C/O

HTN ,K/C/O TYPE 2 DM .PATIENT WAS MANAGED CONSERVATIVELY WITH 25 PERCENT

DEXTROSE IFUSION ,ANTI EPILEPTICS ,ANTI HYPERTENSIVES,ANTI PLATELETS AND OHA

WERE CHANGED TO OPTIMISE BLOOD SUGAR LEVELS.PATIENT IS BEING DISCHARGED IN

HEMODYNAMICALLY STABLE CONDITION.

Investigation

COMPLETE BLOOD PICTURE (CBP) HAEMOGLOBIN 11.5 gm/dl TOTAL COUNT 8400 cells/cumm

NEUTROPHILS 85 % LYMPHOCYTES 10 % EOSINOPHILS 01 % MONOCYTES 04 % BASOPHILS

00 % PLATELET COUNT - 1.93

RBC COUNT- 3.80

COMPLETE URINE EXAMINATION (CUE) 19-12-2024 05:15: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 Nil

HBsAg-RAPID 19-12-2024 NegativeAnti HCV Antibodies - RAPID 19-12-2024 Non Reactive

HBA1C 6.4%

BLOOD SUGAR RANDOM

RBS:73

FBS 84 mg/dl

PLBS 134 mg/dl

Hba1c 5.8 %

RFT 19-12-2024 05:15:PMUREA 98mg/dl CREATININE 3.2 mg/dlURIC ACID 5.5 mmol/LCALCIUM

9.7 mg/dlPHOSPHOROUS 2.5 mg/dlSODIUM 136 mmol/LPOTASSIUM 4.0mmol/LCHLORIDE 106

mmol/L

RFT 20-12-2024 05:15:PMUREA 69 mg/dlCREATININE 3.2 mg/dlURIC ACID 4.6 mmol/LCALCIUM

9.5 mg/dlPHOSPHOROUS 3.1 mg/dlSODIUM 136 mmol/LPOTASSIUM 4.0mmol/LCHLORIDE 106

mmol/L

RFT 21-12-2024 05:15:PMUREA 63 mg/dlCREATININE 2.8 mg/dlURIC ACID 4.0 mmol/LCALCIUM

9.3 mg/dlPHOSPHOROUS 2.8 mg/dlSODIUM 138 mmol/LPOTASSIUM 3.6mmol/LCHLORIDE 106

mmol/L

LIVER FUNCTION TEST (LFT) 19-12-2024 01:10AMTotal Bilurubin 0.59 mg/dl Direct Bilurubin 0.15

mg/dlSGOT(AST) 21 IU/L 31-0 IU/LSGPT(ALT) 24 IU/L 34-0 IU/LALKALINE PHOSPHATASE 201

IU/L 98-42 IU/LTOTAL PROTEINS 7.0 gm/dl 8.3-6.4 gm/dlALBUMIN 4.22 gm/dl 5.2-3.5 gm/dlA/G

RATIO 1.52

MRI BRAIN PLAIN SCAN DONE ON 19-12-24

IMPRESSION ;

CHRONIC INFARCT IN LEFT STRIATOCAPSULAR REGION

CHRONIC INFARCT IN RIGHT PARAMEDIAN PONS

CHRONIC OCCLUSION OF RIGHT ICA , HOWEVER NORMAL FLOW IN MCA AND ACA

Treatment Given(Enter only Generic Name)

T.LEVIPIL 500M PO/BD

T.AMLONG 5MG PO/BD

T.NEPRHOSAVE PO/BD

T.ECOSPLRINE AV 75/10 PO/HS

TAB REJUNEX CD3 PO/OD

Advice at Discharge

TAB.LEVIPIL 500MG PO BD TO CONTINUE

TAB.AMLONG 5MG PO OD TO CONTINUE

TAB.ECOSPIRINE AV 75/10 MG PO HS TO CONTINUE

TAB NEPRHOSAVE PO /BD FOR 2 WEEKS

TAB REJUNEX CD3 PO/OD X 2WEEKS

Follow up on february 2025

FBS 111 mg/dl

PLBS 145 mg/dl

Hba1c 5.9%