quadriparesis
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A 34 year old male patient who is resident of Nalgonda and farmer by occupation came in the casualty with chief complaints of weakness of both lower limbs and partial weakness of upper limbs since 4 days.
Patient was apparently asymptomatic 4 days back while he was dancing in Ganesh nimarjanum. Patient suddenly fell on the floor due to loss of power in B/L lower limbs which was sudden in onset. He got up with the help of people around him. He has done his routine after he fell with out any problem ( i.e catching objects, mixing food, taking food from plate to his mouth, going to washroom) that day. The next day he felt weakness in his legs as soon as he woke up and took support of his wife to walk till bathroom from his bed ( bathroom is not far from bed). He experienced weakness in his both hands later that day but was able to do his routine with some difficulty. His weakness in both hands and legs progressed and is unable to walk and get up from squatting posture. Unable to mix food and hold objects, unable to comb hair.
No h/o tingling and numbness, headache, loss of consciousness, seizures, fever, vomiting, loose stools.
No deviation of mouth and difficulty in swallowing.
He was then taken to Nalgonda hospital
where he was said to have hypokalemia and given correction ( for which no documentation was found ).
Weakness in hands has improved a bit but weakness in legs remained the same.
He then came to our hospital for further treatment
PAST HISTORY:
No h/o of similar complaints in the past. No h/o DM, HTN, TB, epilepsy, asthma.
PERSONAL HISTORY:
Patient has a mixed diet with normal appetite and adequate sleep.Patient has normal bowel movements and regular bladder filling.
Patient has a history of alcoholism since past 20 years. He takes around 90ml of whiskey regularly.
He drinks more occasionally on festivals and gatherings.
No allergic history. No family history.
GENERAL EXAMINATION:
Patient is conscious, coherent, cooperative with moderate nourishment and moderate built.
Patient has no pallor, icterus, cyanosis, clubbing, lymphadenopathy.
Patient has B/L pedal oedema extending upto ankle and is of pitting type.
VITALS : BP - 120/70 MMHG.
PR - 85 BPM.
TEMP - afebrile.
Spo2 - 98% at RA.
GRBS - 102.
SYSTEMIC EXAMNATION:
- CVS: S1 AND S2 heard. No added murmurs.
- RS: Trachea central in position. Chest shape elliptical. No scars or sinuses. No dilated vessels. BAE present.
- P/A: Ovoid in shape. No scars, sinuses. No dilated vessels. No pigmentations. No rise of local temperature. Soft and non tender. No organomegaly. Bowel sounds heard, no bruits.
LOCAL EXAMNATION:
CENTRAL NERVOUS SYSTEM:
- Patient is conscious, coherent and cooperative with well orientation to time, place and person.
- HMS: intact.
- CRANIAL NERVE: intact.
- MOTOR SYSTEM:
TEST. RIGHT. LEFT
1) BULK:
A) INSPECTION: Normal. Normal.
B) PALPATION: Normal. Normal.
C) MEASUREMENTS:
- Upper limb: 24cm 24cm
- Lower limb: 44cm 44cm
2) TONE:
A) Upper limb: Normal. Normal
B) Lower limb: Normal. Normal.
3) POWER:
A) Upper limb:
a) Shoulder joint:
- Deltoid (C5) 4-/5. 4-/5
- Supraspinatus. (C5) 4-/5 4-/5
- Infraspinatus. (C5) 4-/5. 4-/5.
- Rhomboids. (C5) 4-/5. 4-/5
- Serratus anterior. (C5,C6,C7) 4-/5. 4-/5
- Pectoralis major. (C5,C6,C7) 4-/5. 4-/5
- Latissum doris. (C7) 4-/5. 4-/5
b) Elbow joint:
- Flexor muscles:
* Biceps. (C5) 4-/5. 4-/5
* Brachioradialis. (C5,C6) 4-/5. 4-/5
- Extensor muscles:
* Triceps. (C7). 4-/5. 4-/5
c) Forearm and wrist joint:
- Flexor muscles:
* Flexor carpi radialis. (C6,C7). 4-/5. 4-/5
* Flexor carpi ulnaris. (C8). 4-/5. 4-/5
- Extensor muscles:
* Extensor carpi radialis. (C6,C7). 4-/5. 4-/5
* Extensor carpi ulnaris. ( C7). 4-/5. 4-/5
* Extensor digitorum. (C7). 4-/5. 4-/5.
d) Muscles of thumb:
- Abductor muscles:
* Abductor pollicis brevis. (T1). 4-/5. 4-/5.
* Abductor pollicis longus. (C8). 4-/5. 4-/5
- Adductor muscles:
* Adductor pollicis. (T1). 4-/5. 4-/5
- Flexor muscles:
* Flexor pollicis longus. (C8). 4-/5. 4-/5
* Oppenens pollicis. (T1). 4-/5. 4-/5
- Extensor muscles:
* Extensor pollicis brevis (C8). 4-/5. 4-/5
* Extensor pollicis longus. (T1). 4-/5. 4-/5
e) Muscles of hand and fingers:
- Lumbricals and interossei. (C8,T1). 4-/5. 4-/5
- First dorsal introsseus and (T1). 4-/5. 4-/5
palmar introsseus.
- Abductor digiti minimi. (T1). 4-/5. 4-/5
- Flexor digitorum sublimis (C8). 4-/5. 4-/5
- Flexor digitorum profundus. (C8). 4-/5. 4-/5
B) Lower limb:
a) Muscles of hip girdle:
- Iliopsoas: (L1,L2,L3). 2/5. 2/5
- Gluteus Muscles:
* Gluteus medius and (L2,L3). 2/5. 2/5
Gluteus minimus.
* Gluteus maximus (L5,S1) 2/5 2/5
- Quadriceps femoris (L3,L4) 2/5. 2/5
- Hamstrings (except AF). (L4,L5,S1). 2/5 2/5
*(biceps femoris,
semi-tendinosus,
semi- membranosus.)
- Adductor femoris: (L5,S1). 2/5 2/5
b) Muscles of the lower leg and ankle:
- Tibialis posticus. (L4). 2/5 2/5
- Tibialis anticus. (L4,L5) 2/5 2/5
- Peronei (L5,S1). 2/5. 2/5
- Gastrocnemius. (S1). 2/5. 2/5
c) Muscles of the foot and great toe:
- Extensor digitorum longus. (L5). 2/5. 2/5
- Extensor hallucinating longus. (L5,S1). 2/5. 2/5
- Extensor digitorum brevis. (S1). 2/5. 2/5
- Flexor digitorum longus (S1,S2). 2/5. 2/5
- ALL REFLEXS ARE ABSENT.
- ALL SENSATIONS ARE INTACT.
- NO SIGNS OF AUTONOMIC DYSFUNCTION.
- NO SIGNS OF CEREBELLAR DYSFUNCTION.
- NO SIGNS OF MENINGIAL IRRITATION.
- NO SPINAL OR CRANIAL DEFORMITIES.
PROVISIONAL DIAGNOSIS:
? GBS ( ? AIDP)
INVESTIGATIONS:
1) Hemogram ( on 23/09/21):
2) Complete urine examination ( on 23/09/21 ):
3) Liver function test ( on 23/09/21) :
4) Renal function test ( on 23/09/21) :
- Blood urea : 18
- Sr. Creatinine : 0.9
- Sr. Sodium : 142
- Sr. Potassium : 3.2
- Sr. Chloride : 101
5) ECG:
6) 2D- Echo report:
6) Magnetic Resonance Imaging:
a) MRI report:
FINAL DIAGNOSIS:
- ? Quadriparesis under evaluation secondary to GBS (?AIDP)
- B/L symmetrical proximal and distal muscle of upper limb and lower limb and truncated muscle weakness.
- ? Transient hypokalemic
DAY 0:
23/09/21
Patient shifted to medical ward from causalty.
Plan of treatment:
1) IVF ( NS with 1 amp of optineuron) IV @50ML/HR.
2) Inj. PAN 40MG/IV/OD.
DAY 1:
24/09/21
Plan of treatment :
1) IVF - 1amp optineuron in 500 ML NS IV OD.
2) TAB. PAN 40MG PO OD.
3) SYP. POTCHOL 10ML PO BD.
4) INJ. THAIMINE 1amp in 100ML NS TID.
5) TAB. ULTRACET 1/2 TAB QID.
DAY 2
25/09/21
A 34 year old patient with B/L lower limb weakness.
S: C/o pain in B/L ankle. No fever spikes.
O:
Pt is c/c/c. B/L pedal edema extending upto ankle. Tenderness at dorsum of foot on dorsiflexion.
Temp- afebrile to touch.
Bp-110/70 mmHg
Pr- 70 bpm
RR-19 cpm
Spo2- 98%
CVS - S1,S2 +
RS - BAE+
P/A- soft,non tender, bowel sounds heard.
CNS- HMF intact
R. L
Tone - N N
Power - R L
Upper limb 4-/5 4-/5
Lowe limb 2/5 2/5
Reflxes -
B T S K A P
R + + + - - -
L - - - - - -
A:
Quadriparesis (RESOLVING) secondary to? GBS (? AIDP).
- B/L symmetrical proximal and distal muscle of UL and LL and truncal muscle weakness.
- ? Transient hypokalemic paralysis.
PLAN OF TREATMENT:
1) IVF - 1amp optineuron in 500 ML NS IV OD.
2) TAB. PAN 40MG PO OD.
3) SYP. POTCHOL 10ML PO BD.
4) INJ. THAIMINE 1amp in 100ML NS TID.
5) TAB. ULTRACET 1/2 TAB QID.
DAY 3
26/09/21
A 34 year old patient with B/L lower limb weakness.
S: C/o pain in B/L ankle. No fever spikes. Patient is feeling symptomatically better. Power in upper limbs have improved when compared to the time of admission but lower limbs are still the same.
O:
Pt is c/c/c. B/L pedal edema extending upto ankle. Tenderness in the dorsum lo both foot on dorsiflexion.
Temp- afebrile to touch.
Bp-120/80 mmHg
Pr- 75 bpm
RR-19 cpm
Spo2- 98%
CVS - S1,S2 +
RS - BAE+
P/A- soft,non tender, bowel sounds heard.
CNS- HMF intact
R. L
Tone - N N
Power - R L
Upper limb 4-/5 4-/5
Lowe limb 2/5 2/5
Reflxes -
B T S K A P
R + - - - - -
L - - - - - -
A:
Quadriparesis (RESOLVING) secondary to? GBS (? AIDP).
- B/L symmetrical proximal and distal muscle of UL and LL and truncal muscle weakness.
- ? Transient hypokalemic paralysis.
PLAN OF TREATMENT:
1) IVF - 1amp optineuron in 500 ML NS IV OD.
2) TAB. PAN 40MG PO OD.
3) SYP. POTCHOL 10ML PO BD.
4) INJ. THAIMINE 1amp in 100ML NS TID.
5) TAB. ULTRACET 1/2 TAB QID.
Ortho opinion was taken yesterday.
According to them, patient has sustained fracture of neck of 4th and 5th meta-tarsal on Rt and fracture of neck 5th meta-tarsal on Lt.
Foot elevation and crepe bandage for both the legs was advised.
Ortho opinion
DAY 4
27/09/21
A 34 year old patient with B/L lower limb weakness.
S: C/o pain in B/L ankle. No fever spikes. Patient is feeling symptomatically better. Power in upper limbs have improved when compared to the time of admission but lower limbs are still the same.
O:
Pt is c/c/c. B/L pedal edema extending upto ankle. Tenderness in the dorsum both foot on dorsiflexion.
Temp- afebrile to touch.
Bp-120/80 mmHg
Pr- 70 bpm
RR-19 cpm
Spo2- 98%
CVS - S1,S2 +
RS - BAE+
P/A- soft,non tender, bowel sounds heard.
CNS- HMF intact
R. L
Tone - N N
Power - R L
Upper limb 4-/5 4-/5
Lowe limb 2/5 2/5
Reflxes -
B T S K A P
R + + - - - -
L ++ + - - - -
A:
Quadriparesis (RESOLVING) secondary to? GBS (? AIDP).
- B/L symmetrical proximal and distal muscle of UL and LL and truncal muscle weakness.
- Recurrent hypokalemic paralysis.
- B/L neck of meta-tarsal fracture
PLAN OF TREATMENT:
1) IVF - 1amp optineuron in 500 ML NS IV OD.
2) TAB. PAN 40MG PO OD.
3) SYP. POTCHLOR 10ML PO TID.
4) INJ. THAIMINE 1amp in 100ML NS TID.
5) TAB. ULTRACET 1/2 TAB QID.
Lumbar puncture was done yesterday, procedure was uneventful and no complaints were noted.
CSF REPORT:
- sugars : 51.
- proteins : 65.
- total cell count : 1.
- diffential cell count: 100 per lymphocytes.
- ADA :09 U/L
CSF sample shows albunimo cytological dissociation.
Sr. Potassium : 2.6
Sr. Magnesium : 1.8
Urinary electrolytes :
- Na : 225
- K : 20.4
- Cl: 185
DAY 5
28/09/21
A 34 year old patient with B/L lower limb weakness.
S: C/o pain in B/L ankle. No fever spikes. Patient is feeling symptomatically better. Power in upper limbs have improved when compared to the time of admission but lower limbs are still the same.
O:
Pt is c/c/c. B/L pedal edema extending upto ankle. Tenderness in the dorsum both foot on dorsiflexion.
Temp- afebrile to touch.
Bp-120/80 mmHg
Pr- 78 bpm
RR-19 cpm
Spo2- 98%
CVS - S1,S2 +
RS - BAE+
P/A- soft,non tender, bowel sounds heard.
CNS- HMF intact
R. L
Tone - N N
Power - R L
Upper limb 4-/5 4-/5
Lowe limb 2/5 2/5
Reflxes -
B T S K A P
R + + - - - -
L + + - - - -
A:
Quadriparesis (RESOLVING) secondary to? GBS (? AIDP).
B/L symmetrical proximal and distal muscle of UL and LL and truncal muscle weakness.
? Recurrent hypokalemic paralysis.
B/L neck of meta-tarsal fracture.
hypokalemia secondary to renal loss.
PLAN OF TREATMENT:
1) IVF - 1amp optineuron in 500 ML NS IV OD.
2) TAB. PAN 40MG PO OD.
3) SYP. POTCHLOR 10ML PO TID.
4) INJ. THAIMINE 1amp in 100ML NS TID.
5) TAB. ULTRACET 1/2 TAB QID.
Potassium correction was done yesterday i/v/o low potassium yesterday.
Urinary sodium: 225,
Urinary potassium: 20.6,
Urinary chloride: 105.
Serum potassium: 2.8 ----> 3.4
Potassium levels before and after correction.
DAY 5
29/09/21
A 34 year old patient with B/L lower limb weakness.
S: C/o pain in B/L ankle. No fever spikes. Patient is feeling symptomatically better. Power in upper limbs have improved when compared to the time of admission but lower limbs are still the same.
O:
Pt is c/c/c. B/L pedal edema extending upto ankle. Tenderness in the dorsum both foot on dorsiflexion.
Temp- afebrile to touch.
Bp-130/90 mmHg
Pr- 75 bpm
RR-19 cpm
Spo2- 98%
CVS - S1,S2 +
RS - BAE+
P/A- soft,non tender, bowel sounds heard.
CNS- HMF intact
R. L
Tone - N N
Power - R L
Upper limb 4-/5 4-/5
Lowe limb 2/5 2/5
Reflxes -
B T S K A P
R + + + - - -
L + + + - - -
LP showing albumin-cytological dissociation
A:
Quadriparesis (RESOLVING) secondary to? GBS (? AIDP).
B/L symmetrical proximal and distal muscle of UL and LL and truncal muscle weakness.
? Recurrent hypokalemic paralysis.
B/L neck of meta-tarsal fracture.
hypokalemia secondary to renal loss.
PLAN OF TREATMENT:
1) IVF - 1amp optineuron in 500 ML NS IV OD.
2) TAB. PAN 40MG PO OD.
3) SYP. POTCHLOR 10ML PO TID.
4) INJ. THAIMINE 1amp in 100ML NS TID.
5) TAB. ULTRACET 1/2 TAB QID.
Planning to take a neurology consult tomorrow.
DAY 7
30/09/21
A 34 year old patient with B/L lower limb weakness.
S: C/o pain in B/L ankle has subsided. No fever spikes. Patient is feeling symptomatically better. Power in upper limbs have improved when compared to the time of admission but lower limbs are still the same.
O:
Pt is c/c/c. B/L pedal edema extending upto ankle. Tenderness in the dorsum both foot on dorsiflexion.
Temp- afebrile to touch.
Bp-120/89 mmHg
Pr- 90 bpm
RR-16 cpm
Spo2- 98%
CVS - S1,S2 +
RS - BAE+
P/A- soft,non tender, bowel sounds heard.
CNS- HMF intact
R. L
Tone - N N
Power - R L
Upper limb 4-/5 4-/5
Lowe limb 2/5 2/5
Reflxes -
B T S K A P
R ++ + + - - -
L ++ + + - - -
LP showing albumin-cytological dissociation
A:
Quadriparesis (RESOLVING) secondary to? GBS (? AIDP).
B/L symmetrical proximal and distal muscle of UL and LL and truncal muscle weakness.
? Recurrent hypokalemic paralysis.
B/L neck of meta-tarsal fracture.
hypokalemia secondary to renal loss.
PLAN OF TREATMENT:
1) IVF - 1amp optineuron in 500 ML NS IV OD.
2) TAB. PAN 40MG PO OD.
3) SYP. POTCHLOR 10ML PO TID.
4) INJ. THAIMINE 1amp in 100ML NS TID.
5) TAB. ULTRACET 1/2 TAB QID.
Thyroid profile ( done on 29/09/21)
T3: 1.05
T4: 9.70
TSH: 7.16
Sr. Osmolality (on 29/09/21) : 295
On 29/09/21
Spot urine K+: 21.3
Spot urine Na+: 213
29/09/21
Sr. K+: 3.5
Sr. Mg++:1.8
Sr. K+ ( on 30/09/21): 4.3
Neurology consult is taken.
Planning for discharge.
DISCHARGE SUMMARY:
DATE: 30/09/21
WARD: MEDICAL WARD.
UNIT: 4
TREATING FACULTY:
Dr. Prakash (intern)
Dr. Lakshman (intern)
Dr. Supraja (intern)
Dr. Akshara (intern)
Dr. Sowmya (intern)
Dr. Suhas (intern)
Dr. Raveen ( PG 2 )
Dr. Nikitha (PG - 3)
Dr. Vaishnavi (PG - 3)
Dr. Hareen ( SR )
Dr. Arjun ( AP )
Dr. Rakesh biswas ( HOD )
Diagnosis:
- QUADRIPARESIS ( RESOLVING ) SECORDARY TO ? GBS ( ? AIDP );
- B/L SYMMETRICAL PROXIMAL AND DISTAL MUSCLES OF UPPER LIMB AND LOWER LIMB
WITH TRUNCAL MUSCLE WEAKNESS;
- ACUTE ONSET AND PLATEAU PHASE WEAKNESS;
- RECURRENT HYPOKALAMIA PARALYSIS;
- B/L NECK OF META-TARSAL FRACTURE;
- HYPOKALAMIA SECONDARY TO ? RENAL LOSS.
Case History and Clinical Findings:
A 34 year old male patient who is resident of Nalgonda and farmer by occupation came in the
casualty with chief complaints of weakness of both lower limbs and partial weakness of upper limbs
since 4 days.Patient was apparently asymptomatic 4 days back while he was dancing in Ganesh
nimarjanum. Patient suddenly fell on the floor due to loss of power in B/L lower limbs which was
sudden in onset. He got up with the help of people around him. He has done his routine after he fell
with out any problem ( i.e catching objects, mixing food, taking food from plate to his mouth, going to
washroom) that day. The next day he felt weakness in his legs as soon as he woke up and took
support of his wife to walk till bathroom from his bed ( bathroom is not far from bed). He experienced
weakness in his both hands later that day but was able to do his routine with some difficulty. His
weakness in both hands and legs progressed and is unable to walk and get up from squatting
posture. Unable to mix food and hold objects, unable to comb hair.No h/o tingling and numbness,
headache, loss of consciousness, seizures, fever, vomiting, loose stools.No deviation of mouth and
difficulty in swallowing.He was then taken to Nalgonda hospital where he was said to have
hypokalemia and given correction ( for which no documentation was found ).Weakness in hands has
improved a bit but weakness in legs remained the same.He then came to our hospital for further
treatment.
PAST HISTORY: No h/o of similar complaints in the past. No h/o DM, HTN, TB, epilepsy, asthma.
PERSONAL HISTORY: Patient has a mixed diet with normal appetite and adequate
sleep.Patient has normal bowel movements and regular bladder filling.Patient has a history of
alcoholism since past 20 years. He takes around 90ml of whiskey regularly.He drinks more
occasionally on festivals and gatherings.No allergic history. No family history.
GENERAL EXAMINATION:Patient is conscious, coherent, cooperative with moderate nourishment and moderate built. Patient has no pallor, icterus, cyanosis, clubbing, lymphadenopathy.Patient has B/L pedal oedema extending upto ankle and is of pitting type.
VITALS :
BP - 120/70 MMHG.
PR - 85 BPM.
TEMP - afebrile.
Spo2 - 98% at RA.
GRBS - 102.
SYSTEMIC EXAMNATION:-
- CVS: S1 AND S2 heard. No added murmurs.
- RS: Trachea central in position. Chest shape elliptical. No scars or sinuses. No dilated vessels. BAE present.
- P/A: Ovoid in shape. No scars, sinuses. No dilated vessels. No pigmentations. No rise of local temperature. Soft and non tender. No organomegaly. Bowel sounds heard, no bruits.
LOCAL EXAMNATION:
CENTRAL NERVOUS SYSTEM:
- Patient is conscious, coherent and cooperative with well orientation to time, place and person.
- HMS: intact.
- CRANIAL NERVE: intact.
- MOTOR SYSTEM:
TEST. RIGHT. LEFT
1) BULK:
A)INSPECTION: Normal. Normal.
B)PALPATION: Normal. Normal.
C) MEASUREMENTS:
- Upper limb: 25cm 25cm
- Lower limb: 44cm 44cm
2) TONE:
A)Upperlimb: Normal. Normal
B)Lowerlimb: Normal. Normal.
3) POWER:
A) Upper limb: 4-/5 4-/5
B) Lower limb 2/5 2/5
- ALL REFLEXS ARE ABSENT.
- ALL SENSATIONS ARE INTACT.
- NO SIGNS OF AUTONOMIC DYSFUNCTION.
- NO SIGNS OF CEREBELLAR DYSFUNCTION.
- NO SIGNS OF MENINGIAL IRRITATION.
- NO SPINAL OR CRANIAL DEFORMITIES.
Investigation:
1) HEMOGRAM:
23/09/21 - HB: 12.1, TC: 8,100, PC: 1.3 LAKH.
28/09/21 - HB: 11, TC: 4,900, PC: 1.3 LAKH.
2) MRI CERVICAL SPINE WITH WHOLE SPINE SCREENING:
C3-C4 AND C5-C6 DISC OSTEOPHYTE CAUSING MILD CANAL STENOSIS AND RIGHT NEURAL
FORAMINAL STENOSIS AT C5-C6.
3) SERUM POTASSIUM LEVELS:
23/09/21 - 3.2 ( 1 AMP OF KCL IN 500ML OF NS IS GIVEN) >>3.4 ( ON 24/09/21 - AFTER
CORRECTION ),
26/09/21 - 3.1,
27/09/21 - 2.8 ( 2 AMP OF KCL IN 500ML OF NS IS GIVEN) >>3.4 ( ON 27/09/21 - AFTER
CORRECTION ),
28/09/21 - 3.5
29/09/21 - 3.5.
30/09/21 - 4.3.
4) SERUM MEGNESIUM ( ON 29/09/21) - 1.8
5) SERUM OSMOLARITY ( ON 29/09/21) : 295
6) ABG ( ON 27/09/21 ):
PH - 7.464
PCO2 - 30.2
PO2 - 95.9
HCO3 - 21.3
7) THYROID PROFILE ( ON 29/09/21) : T3 - 1.05; T4 - 9.7; TSH - 7.16.
8) CSF ANALYSIS ( ON 27/09/21):
SUGARS: 61;
PROTEIN: 56;
CHLORIDE; 115;
CELL COUNT: 1 ;
DIFFENRENTIAL COUNT: 100 PER LYMPHOCYTE .
ADA: 09 U/L
- LP SHOWING ALBUMINO-CYTOLOGICAL DISSOCIATION.
9) URINARY ELECTROLYTES:
- 25/09/21: NA- 252, K- 13.9, CL- 211
- 26/09/21: NA- 225, K- 20.4, CL- 185
- 29/09/21: NA- 213, K- 21.3
10) SPOT PROTEIN / CREATINE RATIO
- 25/09/21: 0.56
- 26/09/21; 0.45
11) 2D-ECHO REPORT SCREENING ( ON 24/09/21 ):
- NO RWMA
- TRIVIAL AR; NO MR/TR
- NO AS/MS
- EF: 60 %
- GOOD LV SYSTOLIC FUNCTION
- NO DIASTOLIC DYSFUNCTION
- NO PAH/PE
- IVC SIZE: 1.55CM.
12) CSF CULTURE: NO GROWTH, NO AFB ARE SEEN.
Treatment Given (Enter only Generic Name)
DAY 0 ( ON 23/09/21)
1) IVF 1 NS WITH 1 AMP OF OPTINEURON IV
2) INJ. PAN 40 MG/IV/OD.
DAY 1 ( ON 24/09/21)
1) IVF 1 AMP OF OPTINEURON IN 500ML NS/IV/OD.
2) TAB. PAN 40 MG/PO/OD.
3) SYP POTCHLOR 10ML PO/BD.
4) INJ. 1 AMP KCL (20MEQ) IN 500ML NS OVER 4-6 HOURS.
5) TAB. ULTRACET PO/QID.
6) INJ.THIAMINE 1 AMP IN 100ML NS/IV/TID.
DAY 2 ( ON 25/09/21 )
1) IVF 1 AMP OF OPTINEURON IN 500ML NS/IV/OD.
2) TAB. PAN 40 MG/PO/OD.
3) SYP POTCHLOR 10ML PO/BD.
4) TAB. ULTRACET PO/QID.
5) INJ.THIAMINE 1 AMP IN 100ML NS/IV/TID.
DAY 3 ( ON 26/09/21 )
1) IVF 1 AMP OF OPTINEURON IN 500ML NS/IV/OD.
2) TAB. PAN 40 MG/PO/OD.
3) SYP POTCHLOR 10ML PO/BD.
4) TAB. ULTRACET PO/QID.
5) INJ.THIAMINE 1 AMP IN 100ML NS/IV/TID.
DAY 4 ( ON 27/09/21 )
1) IVF 1 AMP OF OPTINEURON IN 500ML NS/IV/OD.
2) TAB. PAN 40 MG/PO/OD.
3) SYP POTCHLOR 10ML PO/BD.
4) INJ. 2 AMP KCL (20MEQ) IN 500ML NS OVER 4-6 HOURS.
5) TAB. ULTRACET PO/QID.
6) INJ.THIAMINE 1 AMP IN 100ML NS/IV/TID.
DAY 5 ( ON 28/09/21 )
1) IVF 1 AMP OF OPTINEURON IN 500ML NS/IV/OD.
2) TAB. PAN 40 MG/PO/OD.
3) SYP POTCHLOR 10ML PO/TID
4) TAB. ULTRACET PO/QID.
5) INJ.THIAMINE 1 AMP IN 100ML NS/IV/TID.
DAY 6 ( 29/09/21 )
1) IVF 1 AMP OF OPTINEURON IN 500ML NS/IV/OD.
2) TAB. PAN 40 MG/PO/OD.
3) SYP POTCHLOR 10ML PO/TID.
4) TAB. ULTRACET PO/QID.
5) INJ.THIAMINE 1 AMP IN 100ML NS/IV/TID.
DAY 7 ( ON 30/09/21 - DATE OF DISCHARGE )
O/E:
HMF: INTACT
TONE: NORMAL IN BOTH UL AND LL
POWER: 4-/5 IN BOTH UL AND 2/5 IN BOTH LL
1) IVF 1 AMP OF OPTINEURON IN 500ML NS/IV/OD.
2) TAB. PAN 40 MG/PO/OD.
3) SYP POTCHLOR 10ML PO/TID.
4) TAB. ULTRACET PO/QID.
5) INJ.THIAMINE 1 AMP IN 100ML NS/IV/TID.
Advice at Discharge:
1) INJ CLEXANE 40MG/SC/OD FOR 1 WEEK.
2) PHYSIOTHERAPY FOR BOTH LL
3) SYP. POTCHLOR PO/BD FOR 1 WEEK.
4) TAB. MVT PO/OD.
Follow Up:
REVIEW AFTER 1 WEEK TO GM OP ALONG WITH NERVE CONDUCTION STUDIES OR REVIEW
SOS.
