STATUS EPILEPTICUS(RESOLVED) SECONDARY TO OLD INFRACT IN RT PARIETAL AND TEMPORARY REGIONS K/C/O HTN SINCE 2 YEARS CVA 1 YR AGO POST EXTUBATION

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63YR OLD MALE CHIEF COMPLAINTS OF INVOLUNTARY MOVEMENTS IN LEFT UPPER LIMB AND LOWER LIMB SINCE 2 YEARS

HOPI:

PATIENT WAS APPARENTLY ASYMPTOMATIC TILL 2 YEARS AGO,HE THEN DEVELOPED INVOLUNTARY MOVEMENTS SUDDEN IN ONSET ,STARTED WITH INITIAL CRAMPS,INNVOLUNTARY MOVEMENTS.LASTED FOR 10 MINS FOLLOWED BY POST ICTAL CONFUSION.INVOLUNTARY MOVEMENTS STARTS AGAIN AFTER 30 MINS AND LASTED FOR 1 HR,ASSOCIATED WITH DROOLING OF SALIVA,UPROLLING OF EYEBALL,INVOLUNTARY MICTURITION.
NO H/O FEVER,COUGH,VOMITING,LOOSE STOOLS,PAIN ABDOMEN,GIDDINESS.

N/H/O WEAKNESS IN RT UPPER LIMB AND LOWER LIMB,BLURRING OFVISION.

PAST HISTORY:

K/C/O HTN 2 YEARS ON TAB CINOD 10 MG PO/OD

CVA LT HEMIPARESIS 1YR AGO ON TAB.ECOSPIN AV 150/20 PO/OD

GENERAL EXAMINATION

PT IS C/C/C

NO SIGNS PALLOR, ICTERUS,CYANOSIS,CLUBBING,OEDEMA OF FEET

TEMP 96.8 F

PR 122 BPM

RR 24 CPM

BP 120/80 MM HG

SPO2 98 @ RA

GRBS 103 MG/DL

TREATMENT HISTORY- 2YRS ON TAB CINOD 10 MG PO/OD

PERSONAL HISTORY

ALCHOL-STOPPED USAGE 1.5 YEARS AGO

CVS S1 S2 HEARD

RS BAE +

GIT SOFT NT

CNS LEVEL OF CONSCIOUSNESS - STUPOROUS

SPEECH NO RESPONSE

NO MENINGEAL SINGS

CRANIAL CANNOT BE ELICITED

MOTOR SYSTEM

TONE    RT       LT

UL          N       N

LL         N        N

POWER UL AND LL - CANNOT BE ELICITED

SENSORY SYSTEM-CANNOT BE ELICITED

GLASGOW SCALE- E2 V1 M2

INVESTIGATION:

ABG   15-12-2023 07:18:PM   PH 7.30    PCO2 46.3    PO2 116    HCO3 22.3    St.HCO3 21.2    BEB -3.9    BEecf -3.1    TCO2 43.4    O2 Sat 96.5    O2 Count 22.7	RFT   15-12-2023 07:35:PM   UREA 27 mg/dl 50-17 mg/dl  CREATININE 0.9 mg/dl 1.3-0.8 mg/dl  URIC ACID 9.0 mg/dl 7.2-3.5 mg/dl  CALCIUM 10.0 mg/dl 10.2-8.6 mg/dl  PHOSPHOROUS 2.1 mg/dl 4.5-2.5 mg/dl  SODIUM 146 mEq/L 145-136 mEq/L  POTASSIUM 3.1 mEq/L 5.1-3.5 mEq/L  CHLORIDE 104 mEq/L 98-107 mEq/L
PHOSPHOROUS   15-12-2023 07:35:PM 2.1 mg/dl 4.5-2.5 mg/dl	LIVER FUNCTION TEST (LFT)   15-12-2023 07:35:PM   Total Bilurubin 0.88 mg/dl 1-0 mg/dl  Direct Bilurubin 0.19 mg/dl 0.2-0.0 mg/dl  SGOT(AST) 22 IU/L 35-0 IU/L  SGPT(ALT) 20 IU/L 45-0 IU/L  ALKALINE PHOSPHATE 195 IU/L 119-56 IU/L  TOTAL PROTEINS 7.0 gm/dl 8.3-6.4 gm/dl  ALBUMIN 4.3 gm/dl 4.6-3.2 gm/dl  A/G RATIO 1.59
HBsAg-RAPID   15-12-2023 07:35:PM Negative	Anti HCV Antibodies - RAPID   15-12-2023 07:35:PM Non Reactive
SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM   16-12-2023 04:10:AM   SODIUM 135 mEq/L 145-136 mEq/L  POTASSIUM 3.7 mEq/L 5.1-3.5 mEq/L  CHLORIDE 98 mEq/L 98-107 mEq/L  CALCIUM IONIZED 1.10 mmol/L mmol/L	T3, T4, TSH   16-12-2023 04:10:AM   T3 1.30 ng/ml 1.87-0.87 ng/ml  T4 14.55 micro g/dl 12.23-6.32 micro g/dl  TSH 0.82 micro Iu/ml 5.36-0.34 micro Iu/ml
ABG   16-12-2023 07:24:AM   PH 7.241    PCO2 48.4    PO2 83.9    HCO3 20.1    St.HCO3 18.5    BEB -7.4    BEecf -6.1    TCO2 39.8    O2 Sat 93.5    O2 Count 22.0	ABG   16-12-2023 07:11:PM   PH 7.38    PCO2 41.0    PO2 64.3    HCO3 24.0    St.HCO3 23.8    BEB -0.5    BEecf -0.4    TCO2 45.8    O2 Sat 92.9    O2 Count 21.7
SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM   16-12-2023 10:40:PM   SODIUM 138 mEq/L 145-136 mEq/L  POTASSIUM 3.7 mEq/L 5.1-3.5 mEq/L  CHLORIDE 98 mEq/L 98-107 mEq/L  CALCIUM IONIZED 1.09 mmol/L mmol/L	ABG   16-12-2023 11:21:PM   PH 7.34    PCO2 45.0    PO2 103    HCO3 24.1    St.HCO3 23.3    BEB -1.3    BEecf -0.8    TCO2 47.0    O2 Sat 97.0    O2 Count 21.4
RFT   16-12-2023 11:22:PM   UREA 42 mg/dl 50-17 mg/dl  CREATININE 0.8 mg/dl 1.3-0.8 mg/dl  URIC ACID 4.4 mg/dl 7.2-3.5 mg/dl  CALCIUM 10.1 mg/dl 10.2-8.6 mg/dl  PHOSPHOROUS 3.5 mg/dl 4.5-2.5 mg/dl  SODIUM 137 mEq/L 145-136 mEq/L  POTASSIUM 4.5 mEq/L 5.1-3.5 mEq/L  CHLORIDE 98 mEq/L 98-107 mEq/L	ABG   16-12-2023 11:22:PM   PH 7.315    PCO2 49.0    PO2 65.6    HCO3 24.2    St.HCO3 22.4    BEB -2.2    BEecf -1.2    TCO2 47.2    O2 Sat 90.9    O2 Count 21.1
ABG   17-12-2023 04:13:PM   PH 7.43    PCO2 36.3    PO2 83.9    HCO3 24.1    St.HCO3 25.0    BEB 0.7    BEecf 0.4    TCO2 48.3    O2 Sat 96.2    O2 Count 16.6	RFT   18-12-2023 03:34:AM   UREA 41 mg/dl 50-17 mg/dl  CREATININE 0.8 mg/dl 1.3-0.8 mg/dl  URIC ACID 3.2 mg/dl 7.2-3.5 mg/dl  CALCIUM 9.6 mg/dl 10.2-8.6 mg/dl  PHOSPHOROUS 2.0 mg/dl 4.5-2.5 mg/dl  SODIUM 138 mEq/L 145-136 mEq/L  POTASSIUM 4.2 mEq/L 5.1-3.5 mEq/L  CHLORIDE 99 mEq/L 98-107 mEq/L
SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM   18-12-2023 11:36:PM   SODIUM 130 mEq/L 145-136 mEq/L  POTASSIUM 3.0 mEq/L 5.1-3.5 mEq/L  CHLORIDE 98 mEq/L 98-107 mEq/L  CALCIUM IONIZED 1.12 mmol/L mmol/L

DIAGNOSIS:

STATUS EPILEPTICUS(RESOLVED) SECONDARY TO OLD INFRACT IN RT PARIETAL AND TEMPORARY REGIONS

K/C/O HTN SINCE 2 YEARS CVA 1 YR AGO

POST EXTUBATION

TREATMENT:

NEB IPRAVET 6TH HRLY

NEB.BUDECORT 12TH HRLY

TAB.AMOXYCLAV 625MG PO/BD

TAB.METROGYL 400 400 MG PO/TID

TAB.LEVIPIL 500 MG PO/TID

TAB.SODIUM VALPROATE 500 MG PO/BD

TAB.PAN 40 MG PO/OD/BBF

INJ.LORAZEPAM 2CC/IV/STAT IF SEIZURE ACTIVITY)

TAB.ECOSPRINE AV 75/20 MG PO/HS

TAB.STROCIT PLUS 800/500 MG PO/OD

TAB.CINOD 10 MG PO/OD

ADVICE AT DISCHARGE:

TAB.LEVIPIL 500 MG PO/TID 8AM-2PM-8PM

TAB.SODIUM VALPROATE 500 MG PO/BD 8AM - 8PM

TAB.PAN 40 MG PO/OD/BBF 7AM

TAB.ECOSPRINE AV 75/20 MG PO/HS 8PM

TAB.STROCIT PLUS 800/500 MG PO/OD 8AM

TAB.CINOD 10 MG PO/OD 8AM