Case 19 - Altered sensorium secondary to Alcohol withdrawal seizures with HFrEF secondary to Beri Beri(wet)

 October 01, 2021
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 patient's clinical problems with collective current best evidence based inputs.


A 32 yr old male, paint shop worker, came to casuality with
 Unresponsiveness since 2-3 hours with passing urine  in clothes after involuntary movements.
 Chronic alcoholic since the time of marriage(10yrs), quantity ~ 1  full bottle / day (exact quantity unknown), had a binge consumption of alcohol since yesterday morning, with no intake of food.
Pt was alone at home this morning; after consumption of alcohol, alleged history of fall, associated with  1 episode of GTCS & feothing, tongue bite, uprolling of  eyes, passed urine in the clothes, and was brought to casuality in an unconscious state, not arousable even on painful stimuli; with BP-70/40MMG, he was resuscitated with Thiamine, Ionotropes, I.V. fluids 
          Spo2:92% on RA
          Not a K/C/O DM, HTN, ASTHMA,   
          No admissions to hospital previously.
Personal History-
Married, Non vegetarian
Appetite-normal
B and B movements- Regular
No known allergies

On examination : 
Pt is c/c/c
Moderately built and nourished
No signs of pallor, icterus, cyanosis, clubbing, lymphadenoapathy, 
Pedal edema

Vitals:
Afebrile
PR: 114 bpm, regular
RR: 21 cpm
BP: 70/40mmHg
SPO2:AT ROOM AIR-92%

Systemic examination :
 CVS:S1,S2 heard
  Apex beat:5th ICS
  Resp: BAE+
  Nvbs heard
  End Exp. Wheeze in all areas
  Position of trachea- central
  P/A: soft, tenderness +,
   bowel sounds heard
   Cns: 
   Level of consciousness-Stuporous
   Speech-No response
   Meningeal signs-negative
GCS- E1V1M3
B/L pupils-Pinpoint
Reflexes-
      B.    T.    S  A    K.     P
      R   2+  2+    2    +    2+  Extensor
      L   2+  2+    2    +    2+  Extensor
      plantars-B/L mute



PROVISIONAL DIAGNOSIS-
Altered sensorium secondary to Alcohol withdrawal seizures with HFrEF secondary to Beri Beri(wet)

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