AMC Unit 3 Bed 1
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Thursday,February 3rd
A 60year old female came with seizures,vomitings,abdominal pain
B.Sushma ,9th semester
Roll no.154
February 3rd,2022
A CASE DISCUSSION ON SEIZURES,VOMITINGS
I've been given this case to solve in an attempt to understand the topic of "patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan.
CASE PRESENTATION:
A 60yr old female, who is a housewife presented to casuality on 2ndmarch2022 with
CHEIF COMPLAINTS of
Seizures( Involuntary movements of bilateral upper and lower limbs)
Presented with irritability and post ictal confusion.
HISTORY OF PRESENT ILLNESS:
Patient was apparently asymptomatic 3days ago then she developed
Vomitings 5 to 6 episodes per day which is of non projectile,non bilious,and food particles as contents associated with abdominal pain which is of diffuse type.
She went to local hospital and then they prescribed tablets but even after then vomitings didnt get subsided
1day ago she developed involuntary movements of B/L upper and lower limbs associated with tongue bite, uprolling of eyes, GTCS type lasting for 2mins associated with involuntary micturition , post ictal confusion present. Aura absent.
Later on she developed fever which is insidious in onset gradually progressive not associated with chills and rigor and subsided with medication.
No c/o cold ,cough,headche,trauma,burning micturition.
PAST HISTORY
No similar complaints in the past.
NO HTN,DM,ASTHMA,epilepsy,CAD
PERSONAL HISTORY
Marital status - married
Occupation - House wife
Appetite - Normal
Diet - vegetarian
Bowel and bladder movements - normal
Addictions - no addictions
.
FAMILY HISTORY
No significant family history .
GENERAL EXAMINATION :
Patient is conscious , in coherant ,non cooperative
No pallor,No icterus , cyanosis , lymphadenopathy, edema
VITALS
Temp:98F
BP : 140/ 80mm Hg
PR : 89beats/ MIN
RR : 16/ MIN
SPO2: 98% on RA
GRBS : 160 mg/dl
SYSTEMIC EXAMINATION
CVS : S1, S2 +
RS : BAE + ,Breath sounds on b/l IAA,IMA heard
P/A : soft , nontender
CNS :Patient is conscious but drowsy
Speech is incoherant
No signs of meningeal irritation
Cranial nerves- NAD
Motor system: NAD
Sensory system: NAD
GCS-E4V2M6
- RIGHT LEFT
PUPIL. NSRL. NSRL
TONE UL NORMAL NORMAL
LL NORMAL NORMAL
POWER UL NORMAL NORMAL
LL NORMAL NORMAL
REFLEXES
a) BICEPS 2+ 2+
b) TRICEPS 2+ 2+
c) SUPINATOR 2+ 2+
d) KNEE 2+ -
e) ANKLE 2+ 2+
f) PLANTAR extensor extensor
INVESTIGATIONS:
Serum electrolytes on 2/03/2022 10:30AM
Serum electrolytes on 2/03/2022 7:30 PM
Spot urine sodium 122mmol/L
Spot urinary potassium 21
Serum for osmolality 269mOSM/kg
Urinary chloride 156mmol/L
ECG on 2/03/2022
Chest X-ray
Ultrasound on 3/03/2022
2D Echo
FEVER chart
MDCT Scan Brain -Plain
PROVISIONAL DIAGNOSIS
Seizures secondary to hyponatremia
TREATMENT
1. Inj Levipil 1gm in 100ml NS/IV stat
2. Inj Pan 40mg /IV/ Stat
3. 3%Nacl infusion @10ml /hour followed by 4th hourly serum electrolytes.
4. 0.9% NS @75ml/hour.
5. Monitor vital hourly.
6. Strict I/O charting.
7.inj.neomal 100ml/iv if temp >101.1F
8.inj.monocef 1gm /iv /bd.
