A 30YEAR OLD MALE WITH ALCOHOLIC WITHDRAWAL SEIZURES WITH ALCOHOL DEPENDENCE SYNDROME , ALCOHOLIC LIVER DISEASE ,LACERATION OVER RIGHT CHIN (5*3*1cm)

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Here is a case i have seen : 

A 30year old male who is a cable operator came with the c/o vomitings since 3days,c/o fall ? Fits 1 episode today evening (2hrs ago) 

HISTORY OF PRESENT ILLNESS:

Patient was apparently asymptomatic 3days back then he developed vomitings ( 2 episodes day before yesterday,4 episodes yesterday) nonbilious,food as content,non projectile

C/o fall at home ( pt not able to recall how he fell, pt attenders were also not present there) on hearing the sound of fall attenders rushed into the house and noticed injury to the chin,clenching of both hands,no h/o any tongue bite ,frothing ,tonic clonic movements,h/o loc + for 30mins according to attenders

No h/o head trauma,ENT bleed,Postictal confusion

HISTORY OF PAST ILLNESS: 
Not a k/c/o DM,HTN,TB, ASTHMA, EPILEPSY CVA,CAD

PERSONAL HISTORY: 
Patient takes mixed diet,sleep adequate,bowel and bladder habits regular, alcoholic since 5yrs and takes daily 90-180ml,did not take alcohol since 3days,non smoker 

DRUG HISTORY: 
No known drug allergies

GENERAL EXAMINATION:
O/E pt is c/c/c, moderately built ,moderately nourished
No pallor
No Icterus
No Cyanosis
No clubbing
No Lymphadenopathy
No Pedal edema 
Vitals:  Temperature- Afebrile
              BP-130/80 
              PR- 73bpm
              RR- 20cpm
              GRBS-161mg/dl

SYSTEMIC EXAMINATION:
CVS-S1S2 +,no murmurs
RS- BAE+,NVBS,no added sounds 
P/A- Soft,nontender,no organomegaly
CNS- Level of consciousness- conscious
          Speech-Normal
          Cranial nerves-Normal
          MOTOR SYSTEM 

                                        Right             Left

Bulk:    inspection       Normal          Normal

             palpation        Normal          Normal


Measurements  U/L   Equal on both sides

                          L/L   Equal on both sides


Tone:          

                         UL       Normal       Normal

                  

                       LL.     Normal       Normal


Power : UL- Rt-5/5, Lt-5/5

            

            LL-Rt-5/5,Lt-5/5

          

Reflexes:

Deep tendon reflexes

                                 Rt.                       Lt.

   Biceps                  2+                         2+

   Triceps                2+                          2+

   Supinator            2+                           2+

   Knee                     2+                        2+

   Ankle                    2+                      2+

Plantars - rt. Side  extensor

                 Lt. Side   flexor

 Sensory system - Normal

 GCS- 15/15
 Gait-Normal 

INVESTIGATIONS:

DAY1:
CBP: Hb-13.1
          TLC- 6100
          PLT-74000
SEROLOGY- Negative
RFT:Urea- 29
        Creatinine-0.7
        UA- 5.9
        Ca2+-10.1
        Po4-2.4
        Na+ - 135
        K+ -4.5
        Cl-98
RBS-97
LFT- T.bilirubin- 3.45
         DB- 1.16
         AST- 83
         ALT-34
         ALP-143
         TP- 5.8
         Albumin-3.73
         A/G-1.8 
CUE: Albumin-trace
         Sugars-Nil
         Pus cells - 2-4
         Epithelial cells- 2-3
         RBC- Nil
CXR- 


ECG- 


USG abdomen-



MRI Brain with MRI venogram: 




PROVISIONAL DIAGNOSIS: ?Alcoholic withdrawal seizure with alcoholic dependence syndrome with alcoholic liver disease 
Laceration over rt side of chin 5*3*1cms

OMFS referral was done i/v/o laceration over rt side of chin and stay suturing was done under 
LA

TREATMENT: INJ PANTOP-40mg IV OD
                         INJ ZOFER 4mg IV TID
                         INJ OPTINEURON 1amp in 100ml
                         NS IV OD 
                         INJ THIAMINE 100mg in 100ml                               NS IV BD
                         INJ LEVIPIL 500mg IV BD 

DAY2: 
No fresh complaints 
O/E pt is c/c PR- 74bpm
                       BP- 130/80 
                       CVS- S1S2+
                       RS-BAE+
                       P/A- Soft,NT
                      CNS- HMF intact 
                                Cranial nerves normal

MOTOR SYSTEM 

                                        Right             Left

Bulk:    inspection       Normal          Normal

             palpation        Normal          Normal


Measurements  U/L   Equal on both sides

                          L/L   Equal on both sides


Tone:          

                         UL       Normal       Normal

                  

                       LL.     Normal       Normal


Power : UL- Rt-5/5, Lt-5/5

            

            LL-Rt-5/5,Lt-5/5

          

Reflexes:

Deep tendon reflexes

                                 Rt.                       Lt.

   Biceps                  2+                         2+

   Triceps                2+                          2+

   Supinator            2+                           2+

   Knee                     2+                        2+

   Ankle                    2+                      2+

Plantars - rt. Side  extensor

                 Lt. Side   flexor

 SENSORY SYSTEM -Normal

                                 

CEREBELLAR SIGNS - Normal


INVESTIGATIONS:

BGT-O+ve

APTT-34sec

HBsAg-Non reactive

Anti HCV antibodies-Non reactive

HIV1/2rapid test-Negative

PT-17sec

INR-1.2

Dengue serology-Negative


TREATMENT: INj.Pantop 40mg IV OD

                         INj.Zofer 4mg IV SOS

                         INJ.Optineuron 1amp in 100 NS 

                              IV OD

                         INJ.Thiamine 100mg in 100ml NS IV TID

                         Tab.Levipil 500mg PO/BD

                         Oral fluids upto 3lit/day

                         Bp/PR/SPO2 charting 4th hrly

                         GRBS charting 12th hrly

                         T bact ointment for application at suture site


Patient was referred to psychiatry i/v/o alcohol dependence syndrome


DAY3:
No fresh complaints 
O/E pt is c/c PR- 64bpm
                       BP- 120/80 
                       CVS- S1S2+
                       RS-BAE+
                       P/A- Soft,NT
                      CNS- HMF intact 

                                Cranial nerves normal

MOTOR SYSTEM 

                                        Right             Left

Bulk:    inspection       Normal          Normal

             palpation        Normal          Normal


Measurements  U/L   Equal on both sides

                          L/L   Equal on both sides


Tone:          

                         UL       Normal       Normal

                  

                       LL.     Normal       Normal


Power : UL- Rt-5/5, Lt-5/5

            

            LL-Rt-5/5,Lt-5/5

          

Reflexes:

Deep tendon reflexes

                                 Rt.                       Lt.

   Biceps                  2+                         2+

   Triceps                2+                          2+

   Supinator            2+                           2+

   Knee                     2+                        2+

   Ankle                    2+                      2+

Plantars - rt. Side  extensor

                 Lt. Side   flexor

 SENSORY SYSTEM -Normal

                                 

CEREBELLAR SIGNS - Normal


INVESTIGATIONS:

Dengue serology-Negative


TREATMENT: INj.Pantop 40mg IV OD

                         INj.Zofer 4mg IV SOS

                         INJ.Optineuron 1amp in 100 NS 

                              IV OD

                         INJ.Thiamine 100mg in 100ml NS IV TID

                         Tab.Levipil 500mg PO/BD

                         Oral fluids upto 2lit/day

                         Bp/PR/SPO2 charting 4th hrly

                         GRBS charting 12th hrly

                         T bact ointment for application at suture site


DAY4: 
No fresh complaints 
O/E pt is c/c PR- 74bpm
                       BP- 130/80 
                       CVS- S1S2+
                       RS-BAE+
                       P/A- Soft,NT
                      CNS- HMF intact 
                                Cranial nerves normal

MOTOR SYSTEM 

                                        Right             Left

Bulk:    inspection       Normal          Normal

             palpation        Normal          Normal


Measurements  U/L   Equal on both sides

                          L/L   Equal on both sides


Tone:          

                         UL       Normal       Normal

                  

                       LL.     Normal       Normal


Power : UL- Rt-5/5, Lt-5/5

            

            LL-Rt-5/5,Lt-5/5

          

Reflexes:

Deep tendon reflexes

                                 Rt.                       Lt.

   Biceps                  2+                         2+

   Triceps                2+                          2+

   Supinator            2+                           2+

   Knee                     2+                        2+

   Ankle                    2+                      2+

Plantars - rt. Side  extensor

                 Lt. Side   flexor

 SENSORY SYSTEM -Normal

                                 

CEREBELLAR SIGNS - Normal


INVESTIGATIONS:

Hemogram: Hb-13.5

                      PLT-4300

                      TLC-75000



TREATMENT: INj.Pantop 40mg IV OD

                         INj.Zofer 4mg IV SOS

                         INJ.Optineuron 1amp in 100 NS 

                              IV OD

                         INJ.Thiamine 100mg in 100ml NS IV TID

                         Tab.Levipil 500mg PO/BD

                         Oral fluids upto 2lit/day

                         Bp/PR/SPO2 charting 4th hrly

                         GRBS charting 12th hrly

                         T bact ointment for application at suture site


DAY5: 
No fresh complaints 
O/E pt is c/c PR- 84bpm
                       BP- 120/80 
                       CVS- S1S2+
                       RS-BAE+
                       P/A- Soft,NT
                      CNS- HMF intact 
                                Cranial nerves normal

MOTOR SYSTEM 

                                        Right             Left

Bulk:    inspection       Normal          Normal

             palpation        Normal          Normal


Measurements  U/L   Equal on both sides

                          L/L   Equal on both sides


Tone:          

                         UL       Normal       Normal

                  

                       LL.     Normal       Normal


Power : UL- Rt-5/5, Lt-5/5

            

            LL-Rt-5/5,Lt-5/5

          

Reflexes:

Deep tendon reflexes

                                 Rt.                       Lt.

   Biceps                  2+                         2+

   Triceps                2+                          2+

   Supinator           2+                         2+

   Knee                     2+                        2+

   Ankle                    2+                      2+

Plantars - rt. Side  extensor

                 Lt. Side   flexor

 SENSORY SYSTEM -Normal

                                 

CEREBELLAR SIGNS - Normal


INVESTIGATIONS:

Hemogram:Hb-11.6

                     TLC-4300

                      PLT-1.1 lakhs/cumm

LFT:TB-1.22

        DB-0.73

        AST-149

        ALT-69

        TP-5.4

        Albumin-3.35 

        A/G ratio-1.63


TREATMENT: INj.Pantop 40mg IV OD

                         INj.Zofer 4mg IV SOS

                         INJ.Optineuron 1amp in 100 NS 

                              IV OD

                         INJ.Thiamine 100mg in 100ml NS IV TID

                         Tab.Levipil 500mg PO/BD

                         Oral fluids upto 2lit/day

                         Bp/PR/SPO2 charting 4th hrly

                         GRBS charting 12th hrly

                         T-bact ointment for application at suture site



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