A 30 year old male with b/l involuntary movements of hands

 A 30 year old male came to casualty with c/o involuntary movements of hands and tingling and numbness in upper limbs and abdomen since yesterday morning 

Patient was apparently asymptomatic 20 days back then he developed fever insidious in onset, gradually progressive, low grade , intermittent not associated with chills and rigors and relieved by medication

He has a history of 4-5 episodes of vomitings 5 days back. Watery, non bilious ,non projectile, with food particles as contents.

Relieved by medication (unknown)

No c/o pain abdomen, loose stools  

c/o burning micturition 2 days back, relieved now

H/o similar complaints in the past(7 years back) (hypokalemiac periodic paresis)

No h/o DM,HTN, asthma, epilepsy,cad, thyroid disorders 

He used to take alcohol occasionally for the past 10 years and stopped taking 1 month back

He takes betel leaf(pan) once in 2 days for the past 10 years 


O/E 

Patient is conscious, coherent and cooperative well oriented to time ,place and person

No signs of pallor, icterus, cyanosis, clubbing, lymphadenopathy,edema






Patient is not willing to let me take clinic images of chest and abdomen 

Vitals:

BP - 100/70mm hg

PR- 86 bpm

RR- 16 cpm

CVS EXAMINATION:

S1,S2 heard no murmurs

RS EXAMINATION:

trachea central

NVBS +

BAE +

P/A EXAMINATION:

Soft, non-tender

Bowel sounds heard

CNS EXAMINATION:

Hyporeflexia (due to hypokalemia) is seen



https://youtube.com/shorts/C_abIEr8Hs4?feature=share

DIAGNOSIS:

HYPOKALEMIA UNDER EVALUATION 

INVESTIGATIONS:

26/06/23



Serum electrolytes

   Na - 139 mEq/L

   K - 2.3 mEq/L

   Cl - 95 mEq/L

   Ca - 1.01 mmol/L

  Mg - 2.0

Urinary electrolytes

  Na- 162 

  K - 7.3 

  Cl - 123

Urine Ph - 7.0

  

  


27/6/23


Xray chest PA View


ECG


28/06/23


CBNAAT REPORT




Xray reporting


    
AFB




TREATMENT:

1)Inj. Kcl 50 mEq in 500 ml NS / IV over 5 hours

2) Inj. Zofer 4mg iv/OD 

3)Inj. Pan 40 mg IV/OD



28/06/2023

AMC-30 YR M

S:

C/O PAIN ABDOMEN 

O:

ON EXAMINATION:

PATIENT IS C/C/C

TEMP: 98 F

BP:100/70 mmHg

PR:86 BPM

RR: 16CPM

CVS:S1,S2 HEARD ,NO MURMURS 

RS:BAE+,NVBS, NO ADDED SOUNDS

P/A: SOFT, NON TENDER

CNS:

 TONE NORMAL IN ALL LIMBS

POWER 5/5 IN ALL LIMBS 

A: 

HYPOKALEMIA UNDER EVALUATION 


P:

1.INJ OPTINEURON 1 AMP IN 100 ML NS IV/OD

2.TAB.PCM 650 MG PO/SOS

3.INJ. KCL 2 AMP IN 500 ML NS IV OVER 5 HOURS

4.SYP. POTCHLOR 15 ML PO/TID


Serum electrolytes at 8 pm


29/06/2023

AMC-30 Y/M


S:

C/O GENERALISED WEAKNESS



O:

ON EXAMINATION:

PATIENT IS C/C/C

TEMP: 98 F

BP:110/70 mmHg

PR:88 BPM

RR: 17CPM

CVS:S1,S2 HEARD ,NO MURMURS 

RS:BAE+,NVBS, NO ADDED SOUNDS

P/A: SOFT, NON TENDER

CNS:

 TONE NORMAL IN ALL LIMBS

POWER 5/5 IN ALL LIMBS 




A: 

PULMONARY KOCHS WITH HYPOKALEMIA



P:

1.INJ OPTINEURON 1 AMP IN 100 ML NS IV/OD

2.INJ. KCL 2 AMP(40MEq)  IN 500 ML NS IV OVER 5 HOURS

3.SYP. POTCHLOR 15 ML PO/TID

Started ATT

4. TAB.ISONIAZID -390mg po/od

5.TAB. RIFAMPICIN- 780mg po/od

6.TAB.PYRIZINAMIDE -1950mg po/od

7.TAB. ETHAMBUTOL 1625mg po/od

8.TAB. PYRIDOXINE 40MG PO/OD


29/06/2023

AMC-30 YR M

ATT STARTED ON 29/06/2023



S:

C/O GENERALISED WEAKNESS



O:

ON EXAMINATION:

PATIENT IS C/C/C

TEMP: 98 F

BP:110/70 mmHg

PR:88 BPM

RR: 17CPM

CVS:S1,S2 HEARD ,NO MURMURS 

RS:BAE+,NVBS, NO ADDED SOUNDS

P/A: SOFT, NON TENDER

CNS:

 TONE NORMAL IN ALL LIMBS

POWER 5/5 IN ALL LIMBS 




A: 

PULMONARY KOCHS WITH HYPOKALEMIA



P:

1.INJ OPTINEURON 1 AMP IN 100 ML NS IV/OD

2.INJ. KCL 2 AMP(50MEq)  IN 500 ML NS IV OVER 5 HOURS

3.SYP. POTCHLOR 15 ML PO/TID

ATT STARTED 

4. TAB.ISONIAZID -390mg po/od

5.TAB. RIFAMPICIN- 780mg po/od

6.TAB.PYRIZINAMIDE -1950mg po/od

7.TAB. ETHAMBUTOL 1625mg po/od

8.TAB. PYRIDOXINE 40MG PO/OD



30/06/2023

AMC-30 YR M

S:

C/O GENERALISED WEAKNESS



O:

ON EXAMINATION:

PATIENT IS C/C/C

TEMP: 98 F

BP:110/70 mmHg

PR:80BPM

RR: 16CPM

CVS:S1,S2 HEARD ,NO MURMURS 

RS:BAE+,NVBS, NO ADDED SOUNDS

P/A: SOFT, NON TENDER

CNS:

 TONE NORMAL IN ALL LIMBS

POWER 5/5 IN ALL LIMBS 




A: 

PULMONARY KOCHS WITH HYPOKALEMIA



P:

1.INJ OPTINEURON 1 AMP IN 100 ML NS IV/OD

2.INJ PAN 40MG PO/OD

3.INJ.ZOFER 4MG PO/SOS

4.SYP. POTCHLOR 15 ML PO/TID

5. TAB.ISONIAZID -390mg po/od

6.TAB. RIFAMPICIN- 780mg po/od

7.TAB.PYRIZINAMIDE -1950mg po/od

8.TAB. ETHAMBUTOL 1625mg po/od

9.TAB. PYRIDOXINE 40MG PO/OD




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