A 53yr old male patient with seizures
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Date of admission-28th October
A 53 year old male patient farmer by occupation came to the Casuality with chief complaints of vomitings since 1day
History of present illness
Daily routine of the patient:
Patient wokes up at 6am in the morning,have his tea,goes to the field and do the farm work returns home and have his breakfast (rice) at 9am.He is a MPTC member and village who solves public issues.So,he goes to the town and returns home in the evening and have his dinner at 8pm(skips his lunch daily).
Patient was apparently asymptomatic one day back.On the day before his admission into the hospital he attended a wedding,there he had non-veg along with alcohol and on the way to his home he had vomitings.Vomitings:5-6 episodes(first two episodes food as content and next 4episodes watery in consistency)bilious,projectile type.He then went into a state of dehydration and developed seizures.
He also complaints of stomach pain after food occasionally since many years.
No history of diarrhoea.
History of past illness
11months back he had tingling and numbness in head so he went to hyderabad and CT was done showing lacunar infarcts in right thalamus which later reduced spontaneously. He is a known DM since 10years and hypertension since 5years.
Personal history
Patient has no loss of apetite
Mixed diet
No sleep disturbances
Chronic alcoholism since 5years(180ml-daily)
No history of smoking
Family history
Patient father was known case of DM and hypertension
Treatment history
He was on medication for DM and hypertension
General Examination
Patient was conscious ,coherent ,cooperative well oriented to time and place .
No pallor ,icterus ,clubbing ,cyanosis and no generalised lymphadenopathy
VITALS
Temperature-afebrile
Bp -140/70 mm hg
Respiration rate-26 cycles/min
Pulse rate-110 beats/min
Systemic Examination
CVS:
No thrills
Heart sounds -S1 S2heard
No cardiac murmurs
RESPIRATORY SYSTEM
Dyspnea -No
Wheeze-No
Position of trachea -Central
Breath sounds -vesicular
ABDOMEN
Shape of abdomen-obese
No tenderness
No palpable mass
Hernial orifices-normal
No free fluid
No bruits
Liver -Not palpable
Spleen -Not palpable
Bowel sounds -yes
Level of consciousness -drowsy 1arousable
Speech -incoherent
Neck stiffness-No
Kernings sign -No
INVESTIGATIONS
Hb -17.3
TLC -10,900
Platelet -1.99
CUE :
Albumin +
Sugar++++
Pus cells - 3.4
Epithelial cells 2-3
FBS 214mg/dl
Urea -3.1
Creatinine-1.1
Na+ 135
K+ 3.5
Cl- 91
Serology -negative
LFT
Tb -1.60
Db-0.42
SGOT -16
SGPT -11
ALP-121
Tp-6.4
Albumin -3.9
A/G ratio -1.66
TPR graph sheet
Ultrasound report
Provisional diagnosis
Seizures
Treatment
1.1 ampoule thiamine in 100 ml ns
2.inj.Levetiracetam 500mg in 100ml ns
3.inj.pantop 40mg IV OD
4.inj.zofer 4mg IV
5.inj.Lorazepam 2cc IV sos
6.inj.neomol 1gm IV sos
7.tab dolo 650mg
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