Skip to main content

46 yr old male with spasm of limbs

c/o spasm of fingers of upper limbs with tremors since 3 days , excessive sweating , calf muscle pain and generalised weakness since 3 days . 


History of presenting illness:


Patient was apparently normal 10 years ago then he had severe stomach pain and vomitings for which he was admitted to the hospital and was diagnosed to have pancreatitis, he underwent surgery For that and was discharged.


7 years back he went to hospital with complaints of weight loss and weakness,there he was diagnosed with diabetes and was put on oral hypoglycemic drugs , his sugar levels weren’t controlled so he was shifted to insulin . (Past 6 years he is on insulin ) . 


4 months ago in january he had an episode of seizures associated with up rolling of upballs which lasted for one minute, 5 episodes occurred in 30 minutes and in between each episode he had no memory of what had happened. He was admitted in KIMS hospital and was discharged after 5 days . 

He also has delusional episodes at night. 


Since past one week he has spasm of fingers of upper limb with tremors and has decreased pitch of voice.


Past history:


History of trauma to the Achilles tendon in 2007 underwent tendon repair surgery.


Nerve compression surgery 16 yr  Plate was placed


H/o pancreatitis 10 years ago , underwent surgery. 


H/o seizures 4 months ago . 


K/c/o DM since 7 years .

Insulin was taken

2 times a day self administered 

7 unit isophane insulin

7 unit monocomponent human insulin 


N/k/ c/o HTN ,CVA,CAD ,ASTHMA 


personal history

married

Farmer by occupation

Mixed diet

Loss of appetite 

Patient has been smoking since 15 years (10 cigarettes per day ) 

Alcoholic since 15 years . 

He drinks every 2 to 3 months ( 1 week binge drinking  and stops drinking for 2 months ) he has withdrawal symptoms in between drinking episodes ( tremors) .

He had stopped drinking 4 months back after the Epilepsy episode but again started around 10 days back he again started drinking alcohol



Daily routine: 

Before DM(Daily routine)

6 years back he used to do  JCB  business.He wakes up at 7 .Goes from nkp to kattangur, before  having bf.He usually has his bf at 10 and lunch at 2pm .He comes back at 8-9pm ,has his dinner at  and sleeps around 10 am. One day all of the sudden loss of weight for which he went to a local hospital (yashoda) and was found to have DM type 2 (540mg/dl) and was given medication( insulin).He stopped going to work since then and took rest at his home.


After DM

Patient wakes up at 4 am in the morning and collects milk from buffalos and come back to home by 7.30 and supply milk till 9.30am.Takes his breakfast at 10 am and

then takes rest.He has lunch at 1 pm and takes afternoon nap.At 4pm again he goes to buffalo farm and collects milk and supply.Comes back to home by 7.30 he will have his dinner by 9pm and goes to bed by 10pm.



General examination 


Patient is conscious, coherent and co-operative.

Mooderately built and moderately nourished.

Pallor - Absent

Icterus - Absent

Cyanosis - Absent 

Clubbing - Absent 

No lymphadenopathy

Pedal edema- Absent


Vitals : 

Temperature - afebrile 

Blood Pressure - 120/80mm hg 

Pulse Rate -   78 bpm

Respiratory Rate -  18 cpm


SYSTEMIC EXAMINATION: 

PER ABDOMINAL EXAMINATION:


INSPECTION-

Shape of abdomen : flat

Umbilicus : inverted 

All quadrants of abdomen move with respiration 


No visible peristalsis, pulsations, sinuses, engorged veins, hernial sites 


10 cm scar is present on the abdomen 

( pancreatitis surgery) 


PALPATION-

Abdomen soft

No local rise of temperature 

No tenderness

No organomegaly


PERCUSSION:

Resonant note heard over all quadrants.


AUSCULTATION:

Bowel sounds heard  


CVS EXAMINATION:


INSPECTION

The chest wall is bilaterally symmetrical

No dilated veins, scars or sinuses are seen

Apical impulse not visible


PALPATION:

Apex beat localised 




AUSCULTATION:

S1 and S2 heard

No Murmurs 



RS EXAMINATION:


INSPECTION: 

Shape of chest: bilaterally symmetrical

Expansion of chest: Equal on both sides

Position of trachea: Central

No visible scars, sinuses, pulsations



PALPATION:

Inspectory findings confirmed

No tenderness, local rise of temperature

Normal expansion of chest on both sides in all areas

Position of trachea: Central

Vocal fremitus: resonant note felt



PERCUSSION:

Resonant note heard over all areas


AUSCULTATION:

No abnormal respiratory sounds


Vocal resonance: resonant in all areas


CNS EXAMINATION:

HIGHER MENTAL FUNCTIONS- 

Normal

Memory intact


CRANIAL NERVES : normal 


REFLEXES

Normal, brisk reflexes elicited- biceps, triceps, knee reflex elicited and 

b/L ankle reflexes cannot be elicited .


Tremors - present . 


Investigations:


Hemogram :


Hb -14.1 %


T.c -11,400


M-46


L-44


E-01


M-09


B-0


Pcv-40.4


MCH -30.3


MCHC-34.9


RDW-CV -14.3


Plt-3.65 lakh 






Hba1c: 7.2%


FBS :140 mg/dl 




RFT 


UREA-16


Creatinine-0.7


Uric acid -2.5 


Sodium -137


Potassium -4.1 


Chloride -100






CUE :


Albumin - nil 


Sugars - ++++


Pus cells -2 -3 


Cast - nil 


LFT 


TB-1.09


DB-0.39 


SGOT - 18 


SGPT - 10 


ALP - 132 


TP - 5.9 


Alb - 3.98 


A/g - 2.07 




2d echo : 


No MR AR TR 


NO RWMA 


GOOD LV SYSTOLIC FUNCTION


NO DIASTOLIC DYSFUNCTION 


NO PAH/PE 






Treatment:


Tab thiamine 100 mg po/bd 


Inj HAI s/c TID according to GRBS 


Inj NPH s/c according to GRBS


Popular posts from this blog

35 year old female with headache and hearing loss

Image
Hello, I am Y.V.R.Bhargav,a 3rd semester medical student. This is an online elog book to discuss our patients health data after taking his/her consent. This also reflects my patient centered online learning portfolio A 35 year old female, resident of Nalgonda , farmer by occupation came to hospital on 19/9/22 with  CHIEF COMPLAINTS Headache and neck pain since 6 months . Headache was on and off and associated with vomiting. She complaints of hearing loss and tinnitus in right ear and giddiness since 1 month. HISTORY OF PRESENT ILLNESS       The patient was apparently asymptomatic 6months ago.The she had headache associated with neck pain and vomiting.  She complaints of hearing loss and tinnitus in right ear and giddiness while head movement since 1 month. She has no history of fever or chills. No history of ear discharge. PAST   HISTORY       No history of DM       No history of HTN        No hist...
Read more

27 YEAR OLD FEMALE WITH COMPLAINTS OF PAIN IN ABDOMEN

Image
A 27 year old female homemaker resident of Chouttupal came with  chief complaints of  pain in abdomen, nausea and vomiting History of  present illness:  Patient was apparently asymptomatic 4 days back when she developed pain in epigastric region which is insidious in onset, gradually progressive associated with nausea and vomiting. Pain is burning type with slight radiation towards both flanks(Left >> Right). She had history of eating spicy chicken curry and 2 tandoori roti just the night before the pain started, next day morning during drinking tea the pain started. She also has a h/o food intake at irregular intervals. H/o Vomiting since 4 days (3-4 episodes/day), non projectile, non bilious, food as content (initially clear-whitish in color subsequently changed to green-yellowish). No history of cough, chest pain, palpitations, sweating and shortness of breath. No history of burning micturition, hematuria and fever. Past history : No history of Hypertension,...
Read more

63 year ol male with c/o facial puffiness and fever

Image
Hi , I am YVR.Bhargav, 5th semester medical student. This is an online e log of patient's de-identified health data shared after taking his/her/guardian's signed informed consent. Here we discuss our individual patients problems through series of inputs from available global online community of experts with an aim to solve those patients clinical problem with collective current best evident based input.This elog also reflects my patient centered online learning portfolio                                                               I have been given this case to solve in an attempt to understand the topic of  " patient clinical data analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with diagnosis and treatment plan 63 yr old mal...
Read more