Case 36 - SEIZURES UNDER EVALUATION

Patient who does labour work came to casualty with c/o fever since 3 days
Loss of appetite since 2 days
Involuntary movements since 1 day(10 episode s before coming to hospital)
Pain at RT ankle

HOPI :
patient was apparently asymptomatic 4 days ago when she developed fever and loss of appetite since 4days , fever subsided on medication
Patient started involuntary movements since 23/5/22 morning
Patient wakes up daily at 5am cleans house and goes to do labour after eating her breakfast at 8am and has lunch at 1 pm and returns to her house at 5 pm gets freshen up and have dinner at 8pm and sleeps at 10 pm  similar work is done since 20 year

PAST HISTORY
 she is newly diagnosed DM type 2 on treatment with GLIMI -M1
N/K/C/O HTN , ASTHMA , THYROID DISORDERS 

PERSONAL HISTORY
DIET- MIXED
SLEEP -ADEQUATE
APPETITE - NORMAL
BOWEL & BLADDER- REGULAR
ADDICTIONS
Cigarette smoking since 50 years
(Chutta)



GENERAL EXAMINATION:

PATIENT IS CONSCIOUS, COHERENT, COOPERATIVE
ORIENTED TO TIME, PLACE, PERSON

NO PALLOR,NO CLUBBING,NO ICTERUS
NO KOILONYCHIA,NO LYMPHADENOPATHY,
NO EDEMA

VITALS:
TEMP-98.4F
BP-130/60MMHG
PR-84BPM
RR-18CPM

SYSTEMIC EXAMINATION:

CVS -S1S2+,NO MURMURS

RS-BAE+,NVBS HEARD

PA- SOFT , NO TENDERNESS
CNS - SOAP NOTES DAY 1
 24/05/2022


S: four episodes of seizures 


O: 
PATIENT IS C/C/C
No pallor, clubbing, icterus, cyanosis, koilonychia, lymphadenopathy,edema

VITALS :
BP - 140/60 MMHG
PR- 84 BPM
SPO2 - 98%
TEMP - 98°F
CVS - S1 S2 +
RS - BAE +
CNS: pt is c/c/c
Tone: 
R-UL-N, L-UL- N
R- LL- N, L- LL- N
Power:
R-UL:5/5
L-UL:5/5
R-LL:4/5
L-LL:4/5
Reflexes:R, L
B: 2+ , 2+
T: 2+, 2+
S: 2+, 2+
K: 2+,2+
A: 2+ ,2+
Sensory system: NAD
Cranial NS : intact
Meningeal signs:
Kernigs,brudzinski sign Negative
No neck rigidity


INVESTIGATIONS
HEMOGRAM
 CUE

URINE PROTEIN CREATININE RATIO

URINARY ELECTROLYTES

SERUM PHOSPHORUS
LFT
SERUM CREATININE
SERUM ELECTROLYTES


SERUM MAGNESIUM

BLOOD UREA
RBS
FBS

BGT

USG ABDOMEN

CHEST XRAY

DIAGNOSIS
Focal seziure with secondary generalisation with impaired awarness
DENOVO DETECTED DM TYPE 2

TREATMENT
1) inj.phenytoin 100mg IV TID
2) inj.lorazepam 2cc  IV SOS
3) IVF NS @100 ML/ HR
4) STRICT I/ O CHARTING
5) VITALS MONITORING 2 HRLY

6) GRBS MONITORING 6 TH HOURLY  

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