A 50 year old male with involuntary movements.

THIS IS AN ONLINE E LOG BOOK 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 SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUT

17/3/22

A 50years old male came to the opd with chief complaints of involuntary movements of both the upper and lower limbs since 2 days.

History of presenting illness:

Patient was apparently asymptomatic 2days (afternoon)back then he developed sudden involuntary movements while doing work in the fields and it continued for 4-5mins then they took him to local hospital there they didn’t admitted him so they went another hospital in the evening and he got admitted there and treated conservatively.

Yesterday morning again he had a sudden involuntary movements for 4mins so they referred to our hospital.

During the admission to our hospital he had another episode of involuntary movements.It is not associated with unrolling of eyes,tongue bite,involuntary micturation and defecation.

He also complained of blurring of vision.

Past history:

No h/o similar complaints in the past.

No h/o hypertension,diabetes,asthma,epilepsy,tuberculosis.

H/o hernioplasty

Family history:

Not significant 

Personal history:

He is farmer by occupation,his daily activities were normal till 6 months back.

His younger son died due to Organophosphorus poisoning from then he started taking more quantities of alcohol and eating less food.

From 5 days he stopped drinking alcohol due to weakness.

Physiological habits:

Diet-mixed

Sleep-adequate 

Appetite-decreased 

Bowel and bladder movements-regular

Addictions-drinks alcohol from past 20 year but increased consumption from last 6months.Smoking 3packs/day.

General examination:

Patient is conscious,coherent, cooperative to time,place and person.moderately built and moderately nourished.

Pallor-present

Icterus-absent

Cyanosis-absent

Clubbing-absent 

Lymphadenopathy-absent

Edema-absent

Vitals:

Temperature:98.5F

Blood pressure:140/90mmHg

Pulse rate:94bpm

Respiratory rate:17cpm

Spo2:99%

GRBS:on admission 24mg%——>25%Dextrose——>246mg%

              7am-117 mg%

              10am-156 mg%

              11am- 151 mg%

              12pm-141 mg%

              1 pm-  165 mg%

—Bilateral swelling over the parotids.

—he has fine tremors of both hands

https://youtube.com/shorts/c-G0MDp-dj4?feature=share

Systemic examination:

CVS-S1S2 heard

RS-BAE+,NVBS+

P/A- tenderness in right hypochondriac,right lumbar,right iliac.

CNS-NFND

Investigations

Hemogram

Hb:7.16

TLC: 7,700

Pcv: 22.8

MCV: 102.7 

MCH: 34.2

MCGC:33.3

RBC: 2.22

PL- 1.40

PS: NC/NCAnemia & Mild thrombocytopenia 

LFT

TB: 0.56

DB: 0.17

AST: 142

ALT: 51

ALP: 190

TP: 4.7

A: 2.44

A/G: 1.08

RFT:

UA : 5.3

S.crt:12.7

Urea:59

Ca++:8.1

Nat: 139 

K+:3.4

Cl-:101

ECG:

USG:

Aortic sclerosis 

Trivial tricuspid regurgitation,aortic regurgitation.

Provisional diagnosis:

Alcohol withdrawal seizures 

Hypoglycaemic seizures?

Treatment:

IVF-NS,RL,DNS 75ml/hr

Inj.PANTOP 40mg/iv/OD

Inj.ZOFER 4mg/iv/sos

Inj.THIAMINE 2Amp iv BD

Tab.LIBRIUM 25mg/po/BD