case 46 : A 65 yr old male with Delirium under evaluation

Saturday, 21 November 2020

A 65 yr old male with Delirium under evaluation , Pre-renal AKI, Non healing ulcer over right foot, Anemia: microcytic hypochromic under evaluation

thanks Dr. Nithisha (intern)

http://nithishaavula.blogspot.com/2020/11/a-65-yr-old-male-with-delirium-under.html

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CASE PRESENTATION

A 65year old male patient shepherd by occupation came with c/o ulcer over dorsum of lt foot since 6 months and disoriented speech since 1 day.

Pt was apparently asymptomatic 6months ago then he sustained trauma to his right lower limb and developed ulcer and right lower limb edema. Pt has been on regular dressings for the ulcer with RMP.

3months ago pt developed left lower limb edema also

1week ago h/o giddiness and fall(pt did not eat food that day),pt did not remember the event of fall but according to attendors there was no loss of consciousness,no trauma,no seizures

Since 5days c/o involuntary micturation,involuntary passing stools and spitting everywhere,altered behaviour, irrelevant talk,visual hallucinations,no orientation to person place

Pt not sleeping since 4days

Decreased appetite since 1week

Occasional alcoholic

smoker since 40 years

Past history:

Not a k/c/o DM,HTN,CAD,CVA, Epilepsy

Personal history:

Mixed diet

Decreased appetite

Sleep not adequate

Bowel and bladder involuntary

Occasional alcoholic

Smoker since 40 yrs

O/E

Pt is conscious, not orientated to time,place and person, thin built

Vitals

Pt is Afebrile

BP - 110/70 mmhg

PR - 82bpm

RR - 16 CPM

CVS - S1S2 heard

RS - BAE present

P/A - soft , non tender

CNS - No neck rigidity, signs of meningitis

Motor and sensory not elicitable

Psychiatry notes:

Day 1:

C/O : sleep disturbance, irrelevant talk , irritability, self talking, decreased appetite since 3 days

Pt was apparently asymptomatic 1week back,he was sitting in the field during day time, pt fell down and was brought to home by village people, pt was taken to a nearby hospital, after 3 days pt started behaving abnormally ,sleep decreased, appetite decreased,self talking,visual hallucinations, irrelevant talk, spitting frequently, involuntarily passing urine

H/O consumption of whiskey 90ml , toddy 500ml occasionally, h/o tobacco smoking since 20 yrs , 2 cigarettes per day , stopped 3 months back (OD denies withdrawal symptoms)

No H/O suspiciouness ,self smiling, low mood , crying spells, fear , palpitations , repititive thoughts, suicidal ideation

MSE - GAB- pt is sitting on bed , frequently trying to go outside of ward

ETEC negative

PMA Normal, rapport CNBE

further MSE CNBE

No Orientation to time ,place , person

DAY 2:

Pt reports to have slept well, decreased irritability

MSE - GAB : pt sitting on the wheel chair, responding to oral commands. PMA normal ETEC present not sustained, rapport established with difficulty

RT increased, relevant, coherent

Affect - dysphoric

Thought and perception - CNBE