Case 36 65 female with fever and altered sensorium

Diagnosis

ALTERED SENSORIUM SECONDARY TO

SEPTIC ENCEPHALOPATHY (RESOLVED)

HYPONATREMIA(RESOLVED)

WITH AKI (RENAL >PRE RENAL)

K/C/O DM TYPE II SINCE 15 YEARS

K/C/O HTN SINCE 10 YEARS

Case History and Clinical Findings

PATIENT WAS BROUGHT TO CASUALITY WITH C/O UNRESPONSIVENESS SINCE 1HOUR

HOPI: PATIENT WAS APPARENTLY NORMAL 1 HOUR BACK SHE THEN SUDDENLY BECAME

UNRESPONSIVE SINCE 1 HOUR ,NOT RESPONDING TO FAMILY MEMBERS .FEVER 1

EPISODE TODAY MORNING RELIVED BY ITSELF ,NO C/O UPROLLING OF EYE BALLS /

TONGUE BITE.NO H/O HEAD INJURY ,TRAUMA

NO C/O VOMITINGS ,NAUSEA, LOOSE STOOLS .H/O INVOLUNTARY PASSAGE OF URINE

PRECEEDED BY INCREASED TONIC ACTIVITY IN UPPERLIMBS

H/O SIMILAR COMPLAINTS 1 DAY BACK FOR WHICH SHE WAS DIAGNOSED AS OHA

INDUCED HYPOGLYCEMIA AND TREATED

PATIENT IS A KNOWN CASE OF DM SINCE 15 YEARS USING TAB.GLIMI-M1 OD ,HTN SINCE 10

YEARS USING T.TELMA-H (40+12.5) OD

NOT A K/C/O CVA ,CVD,THYROID DISORDER ,EPILEPSY,BRONCHIAL ASTHMA

FAMILY HISTORY: NOT SIGNIFICANT

PHYSICAL EXAMINATION NO PALLOR ,ICTERUS ,CYANOSIS,CLUBBING,LYMPHADENOPATHY

TEMP 98.3'F PULSE RATE 110 BPM ,RR:26 CPM BP:110/70 MMHG

SPO2: 99% GRBS 247 MG%

CNS EXAMINATION : GCS : E4V1M4 TONE RIHT LEFT

UL INCREASED INCREASED

LL N N

POWER CAN BE ELICETED

CEREBRAL SIGNS CAN'T BE ELICITED

REFLEXES :ABSENT ,BILAERAL PLANTAR : FLEXOR RESPONSE

OPHTHALMOLOGY REFERRAL DONE I/V/O RAISED ICT ON 5/8

IMPRESSION: NORMALFUNDUS STUDY, NO SIGNS OF RAISED ICT

COURSE IN THE HOSPITAL:

A 65 YEAR OLD FEMALE PATIENT CAME TO CASUALITY WITH COMPLAINTS OF

UNRESPONSIVENESS SINCE 1 HR AND WAS INVESTIGATED FURTHER AND ON

EVALUATION, DIAGNOSED WITH ALTERED SENSORIUM SECONDARY TO SEPTIC

ENCEPHALOPATHY,HYPONATREMIA WITH AKI (RENAL >PRE RENAL) AND K/C/O DM TYPE II

SINCE 15 YEARS, K/C/O HTN SINCE 10 YEARS.AND NECESSARY CONSERVATIVE

MANAGEMENT WAS GIVEN,INJ.CEFTRIAXONE 1GM IV /BD WAS GIVEN FOR 7 DAYS

CT BRAIN WAS DONE AND SHOWING CHRONIC LACUNAR INFARCT IN RIGHT CORONA

RADIATA, CHRONIC SMALL VESSEL ISCHEMIA FOR WHICH TAB.ECOSPIRIN AV 75/20 MG

WAS ADDED

HYPONATREMIA,SEPTIC ENCEPHALOPATHY RESOLVED.

PATIENT IS HEMODYNAMICALLY IMPROVED,SENSORIUM IMPROVED AND FIT FOR

DISCHARGE

Investigation

HEMOGRAM-4/8-5/8-6/8-7/8-8/8-9/8-10/8-11/8

HB-11.1-9.1-8.0-8.1-8.3-9.9-9.1-8.2

TLC-26000-26600-13700-15500-11900-13700-12200-14300

N/L/E/M/B-92/3/1/4/0-89/6/1/4/0-77/15/1/7/0-83/11/1/1/0-83/10/6/1/0-82/12/1/5/0-76/16/1/7/0-

80/13/2/5/0

PCV-29-22.5-20.7-22.1-23.2-26.5-26.2-22.0

RBC-3.27-2.63-2.35-2.42-2.55-2.98-2.73-2.43

PLT-3.53-3.43-2.69-3.28-3.4-2.46-3.96-2.72

HEMOGRAM 0N 12/08/24:

HB-9.4

TLC-19300

PCV-25.0

MCV-90.0

MCH-34.2

RBC-2.75

PLATELET-4.10

CUE- 4/8/24

PUS CELLS-2-3

ALB-NIL

SUGARS-NIL

EPITHELIAL CELLS- NIL

RBCS-NIL

HBA1C- 7.5

PLBS-202 MG/DL

APTT- 29 SEC

PT- 14 SEC

INR-1.0

LEFT

TB-0.63

DB-0.55

ALT-42

AST-45

ALP-135

TP-6

ALB-3.2

A/G-1.15

RFT-4/8-5/8-6/8-7/8-8/8-9/8-10/8-11/8

UREA-94-90-70-50-35-34-32-36

CREATININE-2.3-X-1.5-1.2-1.2-1.2-1.5-1.5

SODIUM-126-130-131-135-135-130-132-131

POTASSIUM-4.5-4.2-3.7-3.2-3.5-4.2-4.1-3.6

CHLORIDE-90-96-99-101-102-101-102-105

CALCIUM-9.7-X-8.8-9.0-9.3-10-10.1-9.8

URINARY ELECTROLYTES 5/8

SODIUM-198

POTASSIUM-16

CHLORIDE-186

USG ABDOMEN 5/8- NORMAL

CT BRAIN-BRAIN 4/8

IMPRESSION: CHRONIC LACUNAR INFARCTS IN RIGHT CORONA RADIATA

CHRONIC SMALL VESSEL ISCHEMIC CHANGES

URINE CULTURE- NO GROWTH

BLOOD CULTURE- NO GROWTH

SPUTUM CULTURE- PSEUDOMONAS AERUOGINOSA ISOLATED

2D ECHO ON 05/08/24 :

NO RWMA

TRIVAL TR+ /MR+ /AR+ : NO PAH

SCLEROTIC AV ; NO AS/MS ;IAS - INTACT

EF: 61% RVSP< 28+ 10 = 38 MHG

GOOD LV SYSTOLIC FUNCTION

GRADE I DIASTOLIC DYSFUNCTION PRESENT

IVC SIZE (0.7CMS) COLLAPSING IVS-1.08 ,EDD: 4.87 , ESD; 3.75 , DPW : 1.008

Treatment Given(Enter only Generic Name)

1) RT FEEDS 50ML WATER 2ND HOURLY ,100ML MILK 4TH HOURLY

2) IV FLUIDS 0.9% NACL @ 75ML/HR

3) INJ. CEFTRIAXONE 1GM IV SOS

4) INJ.NEOMOL 1GM IV SOS (IF TEMP >101'F)

5) INJ PAN 40MG IV OD

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

7) TAB TELMA -4MG RT /OD

8) TAB ECOSPRIN -AV 75/20 RT/ HS

9) TAB PCM 650 MG RT /SOS

10) GRBS 7. PROFILE

11) MONITER VITALS HOURLY

12) POSITION CHANGE 2ND HOURLY

13) SYP POTCHLOR 10 ML IN 1 GLASS OF WATER RT/ TID

Advice at Discharge

T.TELMA 40 MG PO/OD TO CONTINUE

T.CINOD 10 MG PO/OD TO CONTINUE

T.PAN 40 MG PO/OD X 5 DAYS

T.PCM 650 MG PO/SOS

T.ECOSPIRIN AV 75/20 PO/HS TO CONTINUE

T.METFORMIN 500 MG PO/BD TO CONTINUE

SYP.ARISTOZYME 10 ML PO/TID X 5 DAYS

Follow up

Patient is doing well

FBS 100 mg/dl

PlBs 176 mg/dl

Hba1c 6.8 %