55y Male with Hypokalemia associated weakness
The 45yr pt was apparently asymptomatic 7yrs back. one fine day he has noticed difficulty in moving his left Upper and Lower limbs, deviation of mouth to right side. Taken to hospital,diagnosed as Left hemiplegia and treated after which the pt had recovered completely except for some movement restrictiona in the left UL. the symptoms lasted for about 2-3 wks before recovery. now the pt is complaining of weakness in both the lower limbs and right upper limb since 13th April @8pm. the pt was symptom free after the first onset till yesterday evening.
HOPI:
At present pt is c/o weakness of both lower limbs as well as the upper limbs since last night and there was difficulty in holding objects,raising the arm overhead in the Right UL and in the left limb, the pt had minimal movements. in both the lower limbs there was weakness, difficulty to bear weight,gripping of footwear. pt c/o difficulty in breathing even on rest. no orthopnea. no pnd. no h/o fever. no h/o bladder and bowel movements.
PAST HISTORY:
H/o CVA in the past 7yrs back for which the pt had undergone treatment and recovered, except for some residual movement restriction in Left UL
No similar c/o in the past
K/C/O DM type 2 since 7yrs and on medication
VITALS ON ADMISSION:
BP: 110/60mmHg
HR:80bpm
RR:18cpm
TEMP:97.6F
SpO2:99% on RA
GRBS: 235 mg/dL
GENERAL EXAMINATION:
Pt is C/C/C
Pallor present
No icterus/cyanosis/clubbing/koilonychia/lymphadenopathy/edema
Thyroid normal
SYSTEMIC EXAMINATION:
CVS: S1S2 heard
RS: BAE, NVBS
CNS:
Cranial nerves: Intact
Motor system:
POWER: RIGHT,. LEFT
UL: 2/5, 3/5
LL:2/5,2/5
Distal: 3/5
Proximal: 2/5
TONE: Hypotonia of all 4 limbs
Sensory system:N
GCS: 15/15
REFLEXES: RIGHT , LEFT
BICEPS: -, +
TRICEPS:+,+
SUPINATOR:-,-
KNEE:+,+
ANKLE:-,-
PLANTAR: increased, decreased
PROVISIONAL DIAGNOSIS:
?Quadriparesis under evaluation
?Hypokalemic periodic
REPORTS:
14/04/2022:
TREATMENT:
1) INJ. MONOCEF 1g IV BD
2) INJ. PANTOP 40mg IV OD
3)INJ. OPTINEURON in 100 mL NS IV OD
4) INJ. HAI S/C ACC TO GRBS
5)SYP. POTCHLOR 10mL in 1 glass of water TID
6) IV Fluids NS & RL @ 50mL/hr
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