A 46 year old male presented with CC of 
✓ Vomitings Since 10 days
✓ Fever since 10 days 
✓ Generalised weakness and drowsiness since 10 days 

HOPI-
Patient was apparently asymptomatic 1 year back then he had vomitings 1 to 5 episodes/day, non bilious, non projectile, non blood tinged for which he went to a government hospital & got treated.
Prior to vomitings patient had 360 ml of alcohol.

Then after 2 days he had involuntary movements of both upper & lower Limbs - 1episode, which is associated with froathing, tongue bite.
Patient was unconscious during this episode. He was taken to a private hospital & managed conservatively.

10 days back patient had vomitings 2-3 episodes per day, non projectile, non-bilious, 
food particles as contents and not associated with pain in the abdomen.
Patient had fever associated with evening rise of temperature, chills, which is intermittent and relieved on medication.
Generalized weakness and Drowsiness since 10 days.

Past History -
Not a known case of DM, HTN, TB, Asthma.

Personal History-
Appetite - Normal
Diet- Mixed
Bowel and Bladder- Regular 
Sleep- Adequate 
Addictions- Alcoholic from 15 years ( daily takes 90 ml of alcohol)

Drug History - H/o pain killers for back pain.
  
Patient stopped working since 2 years (due to generalized weakness)

On Examination-
Patient is conscious and coherent.
Thin built and nourished.
Vitals
Temp- 98.6° F
PR- 86 bpm
RR- 16 
BP- 90/70 mm Hg
SpO2- 98%
GRBS- 84 mg%

 No pallor, icterus, cyanosis, clubbing, No Generalised lymphadenopathy, No b/l pedal edema.

Systemic Examination:

✓CVS-S1, S2 heard,no murmurs

✓Respiratory System:-
 BAE- present 
NVBS- heard

✓PER ABDOMEN:-
 soft , non tender.

✓CNS- 

No meningial signs

Pupils:- Reactive

Power -          Rt    Lt

Upper limb- 4/5  4/5

Lower limb- 4/5  4/5

Tone-

Upper limb- N    N

Lower limb- N   N

Reflexes:-  Rt   Lt

Biceps.        +     +

Triceps.      +     2+

Wrist.         +     +

Knee.          2+     +
                    


Clinical Images










 Investigations -

10/8/22









11/8/22




Follow up

13/8/21




15/8/22


16/8/22




17/8/22




Previous investigations as on 29/7/22






Provisional Diagnosis:

Metabolic Encephalopathy 2° to Hyponatremia

Hyponatremia 2° to vomitings.

Treatment -



13/8/22



Previous case report -


https://roshinireddy74.blogspot.com/2021/09/general-medicine-case_20.html

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