52 yrs male patient came to casualty with complaints of pain around umbilicus

 Patient came to casualty  with  complaints of pain abdomen since 1month

C/o 4 episodes of   involuntary movements ( GTCS) from since today morning  (each episode lasting for 10 min) with post- ictal confusion of about 30 min, with tongue bite+

No c/o involuntary micturition, defecation. No c/o fever, neck stiffness.

PAST HISTORY:-

k/c/o CVA (right sided ) 4 yrs back not on any antiplatelets.

k/c/o  epilepsy? and on tablet levipil 500mg po BD.

K/c/o Hypertension ,DM since 3 years

PERSONAL HISTORY:-

Stopped drinking alcohol 4yrs back.

VITALS:-

BP- 180/90 mmHg

PR- 99Bpm

RR- 22Cpm

Spo2- 98% at RA 

TEMP- afebrile.

GENERAL EXAMINATION:-

Patient is conscious, coherent, cooperative


No signs of Pallor, Icterus, Cyanosis, Clubbing, Lymphadenopathy or Edema.






Systemic examination:-


CVS-s1s2+


RS- BAE+,NVBS.


P/A-soft , non tender,BS+


CNS- level of consciousness- drowsy, slurred speech.


Cerebral signs( finger- nose co ordination,knee heel coordination) 

:- unable to examine.

No signs of meningeal irritation.

Gait- normal.

Provisional diagnosis:- 

Epileptic disorder with k/c/o CVA ( Rt hemiparesis 4yrs back)  with k/c/o Hypertension with AKI with hyperkalemia with grade I prostatomegaly with left renal calculus(2-3mm)



INVESTIGATIONS:-

X-ray




USG:



ECG:




Hemogram:


Serology:











TREATMENT:-

Inj LEVIPIL 500mg IV/BD

Inj PAN 40mg IV/OD

Inj BUSCOPAN 10mg IV/SOS.

Inj Tramadol 1 amp in 100ml NS/IV/over 30min/SOS.

Tab ECOSPIRIN 75mg Po/OD

Tab ATORVASTATIN 40 mg po/od/HIS.

Inj HAI 12U in 25%dextrose over 30min /stat.

Nebulization with DUOLIN 

Inj MONOCEF 1g/IV/BD













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