NOTE: THIS IS AN ONLINE E LOGBOOK TO DISCUSS OUR PATIENT'S DE-IDENTIFIED HEALTH DATA SHARED AFTER TAKING HIS / HER /GUARDIAN'S SIGNED INFORMED CONSENT. HERE WE DISCUSS OUR INDIVIDUAL PATIENT'S PROBLEMS THROUGH A SERIES OF INPUTS FROM THE AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS INTENDING TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE-BASED INPUT.
75 year old male writer by occupation was born and bought up in Hapur
Milestones achieved normal
Childhood was pleasant
Relationship with family is good. Has two younger sisters and two younger brothers. Not very affectionate but okayish relationship. He had dispute with his father at younger age on studies and responsibilities. As an elder son of his family his father expected him to take certain family responsibilities and pursue higher studies as engineer or science but which the patient is against to.
Education : he graduated with MA in Hindi
Writer by occupation writes short stories, novels usually fiction.
He worked as a publisher. At age 45 he resigned himself as a publisher and many aspects of life because of No mortality benefits
15 years ago his girlfriend died due to motor neuron disease. After his girlfriend’s demise he felt he had some neuro degenerative disorder and had imbalance walking. Necessary investigations were done and was told that he is normal and counselled him. But the patient psychologically believes he has Parkinson’s and started walking with the help of crane since then.
2 years ago on a routine health check up it was found that his BP was 150/80mmhg and was advised to start on anti hypertensives.
Patient was apparently asymptomatic until 15 days ago. He had gradual onset of tremors.
Two days before the hospital admission the patient had urgency of micturition and stools but no passing of urine or stools are noted. Visited doctor and was told his sodium levels are low that is less than 110. Inj 3%NS was given for three days. On third day of hospital stay he was shifted to the room. The patient was apparently doing fine and was speaking little. The same day he had first episode of seizure at 12am. Next day morning he had second episode of seizure and after that episode he lost consciousness and stopped responding since then. It was found that the oxygen sats were dropped to less than 30 during the episode and was placed on ventilator and shifted to max hospital. Stayed there for twelve days and on 13th day he was bought back to Apollo hospital in view of neuro degenerative disorder.
Family history:
History of hyponatremia is present in his family. Previous hospital admission of his father and brother due to hyponatremia.Wife is diagnosed with depressive disorder.
Son is diagnosed with schizophrenia
Outside course in the hospital
Patient presented with above mentioned complaints and possibility of acute encephalopathy was considered. MRI Brain done showed no bleed/ infarct. ECHO done showed jerky septum motion with LVEF 50%- 55%. Patient shifted to ICU for further management. Patient was managed conservatively with iv fluids, iv antibiotic and other supportive supportive measures. LP with CSF done showed TLC <5 cells/ cumm,
Lymphocytes 100%, Glucose 85.3, Protein 40.93. Chest x-ray done showed hyperinflation and was seen by Pulmonologist and advised tracheal culture. Patient was seen by Physician in view of hyponatremia and advice incorporated. On 27/1/2023 patient had an episode of twitching of eye lid with jaw movements and managed accordingly. EEG done showed generalized triphasic waves ? sharp waves. Levetiracetam was added to treatment. Patient also has generalized rigidity; Syndopa was also added to treatment. CPK was 607 IU/L on 27th and 312 IU/L. on 28th. Repeat BEG is planned for today. At present patient is:
DROWSY
GCS :- E4VETM3
PUPILS:- B/L 3MM RTL
NECK SOFT
ON VENTILATOR SUPPORT
ON Going Treatment:
INJ CLINDAMYCIN
IN] MEROSAN
IN] LEVERA
TAB SYNDOPA PLUS
IN] GLANPAN
IN] VOMIKIND
IN] PARACETAMOL
TAB THYRONORM
INJ OPTINEURON
NORMAL SALINE 0.9%
NEB WITH MUCINAC NEB WITH DERINIDE
TAB RIFAGUT
NEB WITH DUOLIN FRESUBIN POWDER
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