NOTE: 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 INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT.
SHE WAS APPARENTLY ASYMPTOMATIC 1 MONTH AGO, THEN HAD BURNING SENSATION ALL OVER 4 LIMBS FOR WHICH SHE WAS TAKEN TO A PRIVATE HOSPITAL IN NALGONDA AND WAS DIAGNOSED WITH PARASTHESIA
6 DAYS AGO, SHE COMPLAINED OF EPIGASTRIC PAIN AND BURNING SENSATION, BURNING MICTURATION FOR WHICH SHE WAS MANAGED CONSERVATIVELY AND DISCHARGED IN THE MORNING
WHILE COMING BACK HOME, AT 4 PM, SHE LOST CONSCIOUSNESS AND INVOLUNTARILY PASSED URINE
NO UPROLLING OF EYES, DRIBBLING OF SALIVA, TONGUE BITE
POST ICTAL CONFUSION +
GAINED CONSIOUSNESS AFTER 15 MIN
ONE EPISODE OF VOMITING ON THE WAY TO HOSPITAL
K/C/O HTN SINCE 3 YRS, ON TELMISARTAN 20MG
NOT K/C/O DM, TB, EPILEPSY, ASTHMA, THYROID, CVA, CAD
PERSONAL HISTORY:
APPETITE NORMAL
DIET MIXED
BOWEL : CONSTIPATION SINCE 3 TO 4 MONTHS
BLADDER : OCCASIONAL BURNING MICTURATION
SLEEP ADEQUATE
NO ADDICTIONS
FAMILY HISTORY: NOT SIGNIFICANT
GENERAL EXAMINATION:
PALOR+
NO ICTERUS, CYANOSIS, CLUBBING, LYMPHADENOPATHY, EDEMA
VITALS:
TEMPERATURE: AFEBRILE
PR: 8T BPM
BP: 110/70 MMHG
RR: 16 CPM
SPO2: 99% AT RA
GRBS: 106 MG/DL
SYSTEMIC EXAMINATION:
CVS: S1,S2 HEARD
RS: BAE +
P/A: SOFT, NON-TENDER
CNS:
ORIENTED TO TIME, PLACE, PERSON
HYPOTONIA IN ALL 4 LIMBS
POWER IS 4/5 IN ALL 4 LIMBS
REFLEXES ( B/L )
B +++
T ++
S +
K +
A +
P FLEXOR
INVESTIGATIONS:
DIAGNOSIS:
ALTERED SENSORIUM
SEIZURES UNDER EVALUATION
ACUTE SYMPTOMATIC HYPONATREMIA ( EUVOLEMIC ) 2⁰ TO SIADH WITH GERD 2⁰ TO LAXLES
K/C/O HTN SINCE 3 YRS
TREATMENT:
IVF 3% NACL AT 10ML/HR IV INFUSION
INJ ZOFER 4 MG IV SOS
INJ BUSCOPAN 1 AMP IV SOS
T PAN D 40/30 PO OD
T PREGABALIN 75MG PO HS
VITAL MONITORING
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