28 yr old male pt presented with history of seizures
A 28 year old male who is a sales man in cloth store, presented to casualty on 22/12/21 with h/o seizures since last night.
History of seizures 3 episodes around 3am, 7am, 11am. Each episode lasting for 3-5 min associated with uprolling of eyeballs, frothing from mouth.
Not associated with tongue bite, involuntary micturition, involuntary defecation, lethal cry.
Followed by post ictal confusion lasting for 15-20 mins
H/o sob since 10 days, grade II - III.
H/o fever 1 week back a/w chills .
No H/o hematuria .
No h/o frothy urine.
No h/o nausea, vomiting, loose stools.
No h/o decreased urine output, pedal edema.
Pt was apparently asymptomatic 10 (February 2021)months back then he noticed sudden loss of weight of about 10-15kgs, in a span of 1 & 1/2 months for which he consulted local doctor where he was diagnosed to have CKD for which he was advised to undergo dialysis I /v/o high creatinine levels. He came to our hospital for dialysis , here he tested COVID + , then he came back for dialysis after 2 months .
K/c/o CKD since April 2021 and is on MHD since June underwent 24 sessions of hemodialysis., Discontinued from 19/10/21.
K/c/o HTN +.since 8 months.
Not a k/c/o DM, CAD, ASTHMA, TB.
Personal history:
Diet: mixed .
Appetite: reduced
B&b: regular.
Sleep: adequate.
No significant family history.
On examination:
Pt is c/c/c moderately built with mild dehydration.
Pallor +, no signs of icterus, cyanosis, clubbing, lymphadenopathy, pedal edema.
Temp: 98.6 f
PR: 88 bpm
RR: 14 cpm
BP: 160/100 mm hg
SpO2: 98% @ RA
GRBS : 130 mg%
CVS: S1, S2+ no murmurs
RS: BAE+, NVBS+
P/A: SOFT, NON TENDER.
CNS: PT IS CONSCIOUS
SPEECH: NORMAL
NO SIGNS OF MENINGEAL IRRITATION.
REFLEXES: R. L.
B. 2+. 3+
T. 3+. 3+.
S. -. 3+.
K. 3+. 3+
A. -. -.
P. REDUCED
POWER: R. L.
UL. 5/5. 5/5
LL. 5/5. 5/5
TONE:. R. L.
UL. N. N.
LL. N. N.
Gait: normal
PD. - ? UREMIC ENCEPHALOPATHY WITH CKD ON MHD
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