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Name : D Arun Kumar
Roll. No. 046
Intern
Case history :
A 38 year old male patient, presented to the OPD with the chief complaints of
1. forgetfulness since 3 months,
2. irrelevant talk since 3 months, and
3.gait disturbances since 2 months.
History of presenting illness :
Patient was apparently asymptomatic 3 years back when he developed pain abdomen and was admitted to various hospitals and was diagnosed with acute pancreatitis.
He was diagnosed with type 2 diabetes mellitus, (secondary to acute pancreatitis) 3 years back. Since lockdown, he has been consuming more than 1litre of whiskey per day.
3 months back he consumed only alcohol without any food for one week, and One day morning, the attenders were unable to wake him up from sleep. He was taken to Mamatha medical College where he was diagnosed with alcoholic ketosis and was on treatment for 2 weeks . Since then , he has not been able to talk, he has not been able to respond to command. He has been unable to remember things and has not been able to do things by himself.
Past history:
patient is a known case of type 2 diabetes mellitus since 3 years and was on medication.
Personal history:
Married
Appetite: normal
Diet: mixed
Bowel and bladder habits : regular
Sleep: adequate
Addictions : alcoholic since 8years , used to consume 1litre of whiskey per day;
smoked 2-4 cigarettes daily since 1 year.
Family history: not significant.
General examination:
The examination was done after obtaining informed consent in a well lit room.
The patient was conscious, well oriented to persons, Not oriented to place and time.
There was no pallor, icterus, clubbing, cyanosis, lymphadenopathy, and edema.
Vitals :
Temperature : afebrile
Pulse rate : 70bpm
Respiratory rate : 20 cps
Blood pressure : 110/70 mmHg
SpO2 : 99% at room temperature.
GRBS : 269 mg/dl
Cvs:
S1, S2 heard
Respiratory system: Bilateral air entry is present.
Abdomen:
Soft, No tenderness, no palpable mass.
Central nervous system :
Conscious, not oriented to time , place and person
Speech: no response.
No signs of meningeal irritation ( no neck stiffness, kerning's sign negetive)
Pupils - NRSL
Rombergs sign - negetive
Right. Left
Tone- UL. N N
LL. N N
Power- UL 5/5 5/5
LL. 5/5. 5/5
Reflexes.
B. +2. 2+
T. +2. 2+
S. +2. 2+
K. - Not elicited -
A. +. +
P. decreased. decreased
Lobar function:
Frontal lobe : unable to perform problem solving, lack of insight.
Parietal lobe : able to perform series of motor activities.
Right and left orientation ---->positive
Finger recognition ---->positive
Visuo-spatial orientation ----> negetiv
Occipital lobe : able to recognise familiar faces.
Investigations:
Normocytic normochromic
Urine examination-
RFT -
CREATININE. : 0.8 mg/dl
PHOSPHORUS : 4.6 mg/dl
SODIUM : 138 mEq/L
POTASSIUM : 4.6 mEq/L
CHLORIDE : 99 mEq/L
LFT-
ALT : 10 IU/L
ALP : 180 IU/L
TOTAL PROTEINS : 6.5 mg/dl
ALBUMIN : 3.77 mg/dl
A/G RATIO : 1.38
ECG-
Vent rate : 60BPM
PR interval : 138ms
QRS duration : 74ms
QT/QTc : 419/419ms
Avg RR : 996ms
P-R-T axes : 12 23 34
MRI
Mild diffusely thinned out Corpus callosum.
Normal grey/white matter differentiation
Nasal ganglia and thalami are normal
Cranio-vertebral and Cervico-medullary junctions are normal.
Sella, pituitary and parasellar regions are normal.
Pituitary gland, pituitary stalk, and hypothalamus are normal.
Provisional diagnosis:
Alcohol induced dementia
K/c/o type 1 diabetes mellitus
K/c/o alcohol dependence syndrome.
Treatment:
Inj. Thiamine 2amp in 100ml NS /IV/ TID
Inj. Human Mixtard S/C --
Tab. Haloperidol 165mg PO/OD
Tab. Pregabalin 75mg PO/MS
Tab. Divalproate 100mg
Tab. Memantine 10 mg
Tab. Sprolit plus 1/2 tab OD
