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

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.





 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




CXR PA VIEW


ECG


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


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