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










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