43 year old man with seizures

43 YEAR OLD MALE WITH SEIZURES


A 43 year old male was brought to the casualty with comlains of involuntary movements of body since today morning. 

HISTORY OF PRESENTING ILLNESS: 
The Patient was apparently asymptomatic 4 days back when he had a binge of alcohol . he lost consciousness at his workplace and was taken to the hospital. At the hospital, the correction fluids were given and the patient was sent home. Today morning he had 2 episodes of involuntary movement of body (tonic movements with stiffening of body) lasting 1-2 minutes and relieved on itself. 
His wife checked his grbs at home after this episode and it was found to be 60mg/dl after which he was rushed to the hospital. In the hospital the correction was done inspite of which involuntary movements continued. He was then brought to our hospital. 
No uprolling of eyes or loss of consciousness during the episodes.
No c/o vomitings, headache, frothing from mouth, deviation of mouth, tongue bite, post ictal confusion, involuntary micturition/defecation.

PAST HISTORY:
No similar complains in the past.
K/C/O DM-II since 5 years on insulin. He was diagnosed with DM-II Incidently during an episode of fever for which he was initially prescribed OHA'S. The patient used to skip taking his medication. Due non compliance and very high sugars he was then shifted to insulin. 
N/k/c/o HTN, CVA, CAD, Bronchial asthma, thyroid disorders. 

DAILY ROUTINE :
The patient works as an attender in a college.
He lives with his wife and three children.
He doesn't always follow his routine and go to the college.
He gets up in the morning and freshens up and has breakfast. After his family leaves for work/college, he either goes to college or goes out with his friends and drinks alcohol. 
He often skips meals as he forgets about them while he is drinking alcohol. He often consumes food late at night when he is very hungry. 
The alcohol consumption has increased in the last 1 year. 
On enquiring about the reason of chronic alcoholism with his family, they say that they can't think of any triggers as such. 


PERSONAL HISTORY
Diet: mixed 
Appetite: lost
Sleep: adequate 
Bowel: regular 
Micturition: normal 
Addictions: drinks alcohol since 20 years, chews gutka since 1 year 
Allergies: nil

Family history: not significant

GENERAL EXAMINATION
Patient is examined in a well lit room after taking an informed consent. 
Patient is conscious and coherent. 
No signs of pallor, icterus, clubbing, cyanosis, generalized lymphadenopathy, pedal edema 









VITAL AT THE TIME OF ADMISSION: (09/07/23) 

Temp: 98F
Pulse: 114bpm
RR: 20cpm
Bp:100/80 mm of hg 
Spo2: 99% at RA
Grbs: 

Systemic examination:

CNS EXAMINATION: 
GCS: 15/15
The patient is conscious. 
Speech: normal
Cranial nerves: intact 
Seonsory system: normal 
Motor system: 
                       UL LL
Tone R INCREASED INCREASED
          L INCREASED INCREASED

POWER
          R 5/5 5/5
          L 5/5 5/5


REFLEXES R L
BICEPS 2+ 2+
TRICEPS 1+ 1+
SUPINATOR 0 0
KNEE 0 0
ANKLE 0 0
PLANTAR E E


RESPIRATORY SYSTEM EXAMINATION 
-Bilateral air entry is present, normal vesicular breath sounds heard. 

CARDIO VASCULAR SYSTEM
S1 and S2 are heard. No murmurs are heard

ABDOMINAL EXAMINATION:
Soft, non-tender. 
No organomegaly
Bowel sounds are heard. 


PROVISIONAL DIAGNOSIS: SEIZURES UNDER EVALUATION SECONDARY TO ? HYPOGLYCEMIA ? TOXIN MEDIATED


INVESTIGATIONS: 

9/07/23
SERUM ELECTROLYTES: 
Na: 145
K: 3.2*
Cl: 99
Ca2+: 1.13
Mg2+: 2

Blood urea 20mg/dl
S. Creatinine: 1 mg/dl
RBS: 130MG/DL

LFT:
total billirubin : 0.98mg/dL
Direct bilirubin: 0.20 mg/dL
AST: 45 IU/L
ALT: 30IU/L
ALP: 301* IU/L
Total proteins: 7 gm/dL
Albumin: 4 gm/dL
A/G ratio: 1.25

Hemogram:
Hb: 10.9gm/dL*
Total count: 6,400cell/mm3*
N/L/E/M/B: 75/18*/2/5/0
PCV: 34.6 vol%*
MCV: 78.6fl*
MCH: 24.8pg*
MCHC: 31.5%
RDW-CV:18.2%*
RBC COUNT: 4.40 millions/mm3*
PLATELET COUNT: 1.92lakhs/mm3
Smear
RBC: normocytic normochromic 


TREATMENT GIVEN: 
INJ. LORAZEPAM 2CC IV/STASTAT
INJ. LEVIPIL 1GM IN 100ML NS IV/STAT
INJ. SODIUM VALPROATE 300MG IN 100ML NS IV/BD
INJ. HAI S/C ACCORDING TO GRBS
INJ. THIAMINE 1AMP IN 100ML NS IV/BD
SYP. POTCLOR 15ml IN 1 GLASS OF WATER

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