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 
 PH7.30 
 PCO246.3 
 PO2116 
 HCO322.3 
 St.HCO321.2 
 BEB-3.9 
 BEecf-3.1 
 TCO243.4 
 O2 Sat96.5 
 O2 Count22.7 
 RFT   15-12-2023 07:35:PM 
 UREA27 mg/dl50-17 mg/dl
 CREATININE0.9 mg/dl1.3-0.8 mg/dl
 URIC ACID9.0 mg/dl7.2-3.5 mg/dl
 CALCIUM10.0 mg/dl10.2-8.6 mg/dl
 PHOSPHOROUS2.1 mg/dl4.5-2.5 mg/dl
 SODIUM146 mEq/L145-136 mEq/L
 POTASSIUM3.1 mEq/L5.1-3.5 mEq/L
 CHLORIDE104 mEq/L98-107 mEq/L
PHOSPHOROUS   15-12-2023 07:35:PM2.1 mg/dl4.5-2.5 mg/dl
 LIVER FUNCTION TEST (LFT)   15-12-2023 07:35:PM 
 Total Bilurubin0.88 mg/dl1-0 mg/dl
 Direct Bilurubin0.19 mg/dl0.2-0.0 mg/dl
 SGOT(AST)22 IU/L35-0 IU/L
 SGPT(ALT)20 IU/L45-0 IU/L
 ALKALINE PHOSPHATE195 IU/L119-56 IU/L
 TOTAL PROTEINS7.0 gm/dl8.3-6.4 gm/dl
 ALBUMIN4.3 gm/dl4.6-3.2 gm/dl
 A/G RATIO1.59 
HBsAg-RAPID   15-12-2023 07:35:PMNegative   
Anti HCV Antibodies - RAPID   15-12-2023 07:35:PMNon Reactive   
 SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM   16-12-2023 04:10:AM 
 SODIUM135 mEq/L145-136 mEq/L
 POTASSIUM3.7 mEq/L5.1-3.5 mEq/L
 CHLORIDE98 mEq/L98-107 mEq/L
 CALCIUM IONIZED1.10 mmol/Lmmol/L
 T3, T4, TSH   16-12-2023 04:10:AM 
 T31.30 ng/ml1.87-0.87 ng/ml
 T414.55 micro g/dl12.23-6.32 micro g/dl
 TSH0.82 micro Iu/ml5.36-0.34 micro Iu/ml
 ABG   16-12-2023 07:24:AM 
 PH7.241 
 PCO248.4 
 PO283.9 
 HCO320.1 
 St.HCO318.5 
 BEB-7.4 
 BEecf-6.1 
 TCO239.8 
 O2 Sat93.5 
 O2 Count22.0 
 ABG   16-12-2023 07:11:PM 
 PH7.38 
 PCO241.0 
 PO264.3 
 HCO324.0 
 St.HCO323.8 
 BEB-0.5 
 BEecf-0.4 
 TCO245.8 
 O2 Sat92.9 
 O2 Count21.7 
 SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM   16-12-2023 10:40:PM 
 SODIUM138 mEq/L145-136 mEq/L
 POTASSIUM3.7 mEq/L5.1-3.5 mEq/L
 CHLORIDE98 mEq/L98-107 mEq/L
 CALCIUM IONIZED1.09 mmol/Lmmol/L
 ABG   16-12-2023 11:21:PM 
 PH7.34 
 PCO245.0 
 PO2103 
 HCO324.1 
 St.HCO323.3 
 BEB-1.3 
 BEecf-0.8 
 TCO247.0 
 O2 Sat97.0 
 O2 Count21.4 
 RFT   16-12-2023 11:22:PM 
 UREA42 mg/dl50-17 mg/dl
 CREATININE0.8 mg/dl1.3-0.8 mg/dl
 URIC ACID4.4 mg/dl7.2-3.5 mg/dl
 CALCIUM10.1 mg/dl10.2-8.6 mg/dl
 PHOSPHOROUS3.5 mg/dl4.5-2.5 mg/dl
 SODIUM137 mEq/L145-136 mEq/L
 POTASSIUM4.5 mEq/L5.1-3.5 mEq/L
 CHLORIDE98 mEq/L98-107 mEq/L
 ABG   16-12-2023 11:22:PM 
 PH7.315 
 PCO249.0 
 PO265.6 
 HCO324.2 
 St.HCO322.4 
 BEB-2.2 
 BEecf-1.2 
 TCO247.2 
 O2 Sat90.9 
 O2 Count21.1 
 ABG   17-12-2023 04:13:PM 
 PH7.43 
 PCO236.3 
 PO283.9 
 HCO324.1 
 St.HCO325.0 
 BEB0.7 
 BEecf0.4 
 TCO248.3 
 O2 Sat96.2 
 O2 Count16.6 
 RFT   18-12-2023 03:34:AM 
 UREA41 mg/dl50-17 mg/dl
 CREATININE0.8 mg/dl1.3-0.8 mg/dl
 URIC ACID3.2 mg/dl7.2-3.5 mg/dl
 CALCIUM9.6 mg/dl10.2-8.6 mg/dl
 PHOSPHOROUS2.0 mg/dl4.5-2.5 mg/dl
 SODIUM138 mEq/L145-136 mEq/L
 POTASSIUM4.2 mEq/L5.1-3.5 mEq/L
 CHLORIDE99 mEq/L98-107 mEq/L
 SERUM ELECTROLYTES (Na, K, C l) AND SERUM IONIZED CALCIUM   18-12-2023 11:36:PM 
 SODIUM130 mEq/L145-136 mEq/L
 POTASSIUM3.0 mEq/L5.1-3.5 mEq/L
 CHLORIDE98 mEq/L98-107 mEq/L
 CALCIUM IONIZED1.12 mmol/Lmmol/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


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