A 65 YEAR OLD MALE
A 65 Y/O MALE PATIENT CAME TO THE CASUALTY IN AN UNRESPONSIVE STATE
HOPI:
THE PATIENT WAS APPARENTLY ASYMPTOMATIC ON 02-SEPT-2021. THEN HE DEVELOPED PEDAL EDEMA WHICH WAS INSIDIOUS IN ONSET GRADUALLY PROGRESSIVE B/L PITTING TYPE UPTO THE KNEE ASSOCIATED WITH DECREASED URINE OUTPUT AND DECREASED APEPTITE FOR WHICH HE APPROACHED LOCAL RMP AND GOT TREATMENT
ON 08-SEPT-2021 MORNING HE WOKE UP FOR MICTURITION AND WHILE COMING BACK TO ROOM HE HAD SUDDEN GIDDINESS AND LOSS OF CONSCIOUSNESS.
HE WAS TAKEN TO NALGONDA HOSPITAL WHERE HE WAS TREATED AND REFERRED TO KIMS NARKETPALLY
PAST HISTORY:
NOT A K/C/O DM, HTN, TB, ASTHMA
PERSONAL HISTORY:
Appetite-Decreased since 1 week
Diet- Mixed
Bowel movements- irregular
Decreased micturition for 1 week
Chronic alcoholic, last binge was 1 week back.
Previous history of Smoking, stopped 20 years back.
O/E:
PT WAS UNRESPONSIVE WITH ALTERED SENSORIUM
BP - 150/100 MM HG
PR - 100BPM
RR-21 CPM
SPO2 - 95%
GRBS - 77 MG/DL
SYSTEMIC EXAMINATION :
CVS - S1,S2 HEARD
NO MURMURS
RS - BAE PRESENT.CREPTS PRESENT IN BOTH RIGHT AND LEFT INFRA AXILLARY AREA
PIA - SOFT NON TENDER, BS +
CNS: DROWSY anisocoria +NORMAL- TONE: RTLTUL N HYPETONIALL N HYPERTONIA
POWER: CANT BE ELICITED IN
BOTH LIMBS-
REFLEXES. DEEP RT LTBICEPS : + + +
TRICEPS : ABSENT
SUPINATOR : ABSENT
ABSENTKNEE JERK: ++ ++ANKLE JERK : + ABSENTPLANTAR FLEXOR MUTE
NO MENINGEAL SIGNS
Investigation:
ECG WAS DONE
MRI BRAIN WAS DONE
Treatment Given:
1. INJ MANNITOL 100 ML/IV/STAT
2. INJ LASIX 40 MG IVISTAT
3.INJ 25% DEXTROSE IV/STAT
ON ADVICE OF NEUROSURGEON PATIENT WAS REFERRED TO HIGHER CENTRE.
F/U:
HE WAS THEN ADMITTED TO NALGONDA GOVT HOSPITAL ON 08/09/21 WHERE HE WAS TREATED FOR THE SAME. NEXT DAY HE LOST CONSCIOUSNESS. PATIENT REGAINED CONSCIOUSNESS FOR ONE HOUR BEFORE HE PASSED AWAY.
