A 70 year old male presented to opd with chief complaints of weakness in both upper limb and lower limb

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A 70 year old male presented to opd with chief complaints of weakness in both upper limb and lower limb Since 1/2/23 evening 

Slurring of speech since 1/2/23 evening 


Patient was apparently asymptomatic till yesterday then he started having pain in both lower limb followed by weakness in both upper limb and lower limb and slurring of speech 

No C/o chest pain,palpitations,sob

No c/o orthopnea,PND 

H/o thorn prick to left LL followed by cellulitis of left ll for which fasciotomy was done 1.year back 

Past history- Not a K/c/o

Htn, DM, TB, Epilepsy,Asthma 


GENERAL EXAMINATION:- 

THE PATIENT IS CONSCIOUS COHERENT AND COOPERATIVE 

NO PALLOR ; ICTERUS; CLUBBING; CYANOSIS; ODEMA ; LYMPHADENOPATHY









TEMPERATURE:- 98.8 F 

PR:92 bpm

BP:140/100 mm Hg

RR-16 cpm

Grbs- 132 mg/dl 

SYSTEMATIC EXAMINATIONS:-


CNS Examination:

Higher mental functions:

Patient is conscious oriented to time place and person 

Speech and language :slurring of speech present 

Memory :intact( Recent,Immediate,Remote)

Hallucinations -absent

Sensory system - Normal 


Motor system-          Right.         Left. 

Tone- Upper limb     Hypo          Hypo

            Lower limb     Hypo           Hypo 

Power- Upper limb     2/5               2/5

              Lower limb      2/5               2/5 

Reflexes- Biceps.        Absent        Absent 

                 Triceps          2 +               2+

                 Supinator.      Absent        Absent 

                Knee                 2+                2+

                Ankle.                1+.                1+

                 Plantar           Mute             Mute 






CVS:S1 S2+,NO MURMURS


RS:BAE+ ; NVBS 

P/A:SOFT ; NON TENDER ; NO ORGANOMEGALY 

Provisional diagnosis-

Quadriparesis secondary to hypokalemia 

  

Investigations- 

2/9/23 

Hemogram 

Hb- 19.3 

TLC - 25,900 

PLT count- 2.95 

PCV - 55.1 

Mcv - 83.9 

Mch- 29.4 


CUE- 

Sugars - nil 

Alb - 3-4 

Pus cells - 3-4 

Epithelial cells - 2-3 


RFT- 

Blood urea - 53 

S.creat- 1.7 

Na+ 130 

K+ # 2.6 

Cl - 100 

S. Magnesium- 1.9 


LFT - 

Tb- 2.25 

Db - 0.48 

Sgot- 29 

Sgpt- 16 

ALP - 211 

TP - 7.7 

Alb - 1.16 


ABG

PH - 7.351




3/9/23 

Hb - 16.4 

Tlc- 20000 

DLC - 2.27 

Rft 

S. Na + 132 

S. K+ 2.7 

S. Cl - 106 


 4/9/23 

Na+ 136

K+ 1.8

Ca+  104 

4/9/23 


S - 

C/o weakness in both upper and lower limb,

C/o slurring of speech 


O - 

Hypokalemic periodic paralysis denovo htn 


A: On examination 

Patient is conscious coherent and cooperative. 

No Pallor, Icterus, cyanosis, clubbing, lymphadenopathy, edema.


Vitals:

Temp: 98.6 F

PR: 72 bpm

BP:120 /80 mm hg

RR: 25 cpm 

CVS: S1 ,S2 heard

RS:B/L AE present , NVBS +. No added sounds

P/A:Soft, non tender, no organomegaly.

No rigidity,Guarding.

CNS:                  Rt                  Lt 

                                           

Tone      U/L     Hyper            Hyper 

               L/L     Normal       Normal 

 Power- U/L    4-/5              4-/5

              L/L     4-/5              4/5

Reflexes- B       3+                 3+

                 T       3+                  3+

                 S.      3+.                3+

                Knee   3+              3+

                Ankle. 1+.                1+

               Plantar  Mute         Mute 


            

P:

1) IV NS @50 ml/hr 

2) Syp. Potklor 15 ml in 1 glass of water PO/TID 

3) T. ECOSPRIN -AV 75/10 Po/ Hs

4) Strict I/o charting 

5)Monitor vitals every 2nd hrly

6)T.Telma 40 mg Po /OD 

7)Inj. Ceftrioxone 1gm IV/ Bd

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