Pt. With Seizures and empty sellar syndrome



  

     This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians signed informed consent. Here we discuss our individual 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 E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome.





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.     


-56 year old female pt. housewife by occupation
 Came to casualty for a  regular checkup.

Chief complaints: 

She came to casualty for regular checkup. 

History of presenting illness: 

•Pt. was apparently asymptomatic 21 years back i.e 1989. 

•She had 1 miscarriage in 1989, 
She couldn't conceive till 1999.

•No history of medication taken for 10 years.

•In 2003, she went for a regular checkup where she's diagnosed with right ectopic kidney, hypothyroidism and hypertension. 

• In 2016, she had recurrent stools for 2 months diagnosed with irritable bowel syndrome. 

•Since past 3 months patient has h/o fever for 3 days followed by generalised weakness and a seizure for which she was admitted in hospital where her B.P was not recordable, diagnosed with septic shock and heart failure with reduced ejection fraction by 35%.
She was put on mechanical ventilator for 2 days and inotrope for 7 days bcz her Sats were not improving. 
- Hospital stay was for 17 days. 
 
•After she was discharged, pt. Felt drowsy for next 2 days and was admitted to hospital again where she's diagnosed with hyponatremia and was put on medication.  She also used meds for schizophrenia. Since her GCS was not improving she was referred to higher center which was later gradually improved. 


                   INVESTIGATIONS

Reduced serum albumin levels and calcium.

HEMATOLOGY : 
 
Reduced Hemoglobin, rbc count, PCV, RDW CV.
DLC shows- Reduced monocytes and eosinophils.




 Negative for hepatitis and HIV 

Physical examination 


 












Current medications : 

Tab. Cilinidipine 10mg 

Tab. Thyronorm 100mcg 

Tab. Levipil 500mg 

Tab. Wysolone 5 mg 

Tab. Pan -D










Comments

Post a Comment

Popular posts from this blog

55 yr old male with polycystic kidney disease

Image
 55 Yr old male, granite cutter by occupation presented to casualty due to swelling of both the feet. Chief complaints:  Swelling of both the feet and shortness of breath from past 2 months. 𝓗𝓲𝓼𝓽𝓸𝓻𝔂 𝓸𝓯 𝓹𝓻𝓮𝓼𝓮𝓷𝓽𝓲𝓷𝓰 𝓲𝓵𝓵𝓷𝓮𝓼𝓼 :   Pt. Was asymptomatic 3 months back then he developed " wet cough ". ( on and off type)  2 months back he developed shortness of breath while doing work.  It was aggravated by work and not relieved by meds.  He also had pedal oedema ( non pitting type) and facial puffiness   since 2 months.  No h/o blood vomiting, no h/o fever.  Past history:  He got his right eye hit by a hard stone due to which he lost his  right eye vision permanently.  He's not a known case of TB/ DM / ASTHMA / epilepsy.  Personal history:  Mixed diet  -Reduced appetite  Adequate sleep -Irregular bowel movements  -Consumes Alcohol and tobacco from past 30 years.  -Pt. has Burning m...
Read more

23 yr old with pancytopenia/ CBBLE UDHC SIMILAR CASES 

Image
      CBBLE UDHC SIMILAR CASES  This is an online e log book to discuss our patient de-identified health data shared after taking his / her / guardians 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 E blog also reflects my patient centered online learning portfolio and your valuable inputs on the comment box is welcome. 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. CHIEF COMPLAINTS :    Pt. Presented to OPD with yellowish discolouration of eyes since 15 days,  fever, abdominal discomfort and shortness of breath on ex...
Read more

65 year old with multiple ulcers over body

Image
 THIS IS AN ONLINE E LOG BOOK 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 SERIES OF INPUTS FROM AVAILABLE GLOBAL ONLINE COMMUNITY OF EXPERTS WITH AN AIM TO SOLVE THOSE CLINICAL PROBLEMS WITH COLLECTIVE CURRENT BEST EVIDENCE BASED INPUT Chief complaints:  65 Yr old male came to opd with Chief complaints of itching followed by blebs formation and spontaneous rupture, ulcers present on both the hands HISTORY OF PRESENTING ILLNESS:  Pt. Was apparently asymptomatic 2 months back then he developed itching all over the body since 2 months. History of painful ulcers over the rt side of Abdomen which healed on taking medication. History of shortness of breath since 1 month. History of loss of appetite since, reduced urine output and pedal oedema since 10 days.  No history of fever Past history: No  history of HTN and DM ,Tb, asthma, thyroi...
Read more