65 year old female with altered sensorium
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CASE PRESENTATION:
A 65 year old female, came with c/o unresponsiveness since 2 days.
Pt was apparently asymptomatic 5 days back ,then she developed pain in right hip and stopped going to work.she also had 1 episode of fever.
She is unable to recognize her family members properly, complaining of some one is going to attack her.
She also had an episode of involuntary urination.
H/O 90 ml alcohol intake every day since 5 years
PAST HISTORY:
Not a k/c/o DM/HTN/TB/ASHTMA/EPILEPSY/CAD
H/O Histerectomy 20 years back
Personal History :
Diet : mixed
Appetite : Normal
Sleep : Adequate
Bowel movements : Normal
Bladder movements : Normal
On Examination :
Patient is unresponsive
Pallor -Absent
Icterus -Absent
Cyanosis -Absent
Clubbing -Absent
Lymphadenopathy -Absent
Edema -Absent
Vitals at presentation
Bp-180/100mmhg
PR-90 bpm
Cvs- s1 s2+
RS- BAE+
CNS-
Pupils at presentation
Bilateral constricted non reactive to light
GCS At admission
E2V1M4
GCS today
E1V1M5
Pupils- (today)right reactive to light.
Power: Couldn’t be elicited
Moving all four limbs to pain
TONE
U/L. Normal. Normal
L/L. Normal. Normal
Reflexes: Right. Left.
Biceps. ++. ++
Triceps. ++. ++
Supinator ++. -
Knee. ++. ++
Ankle - -
Bilateral plantars flexors
Today's vitals
BP-140/80mmhg
PR-67bpm
Treatment:
1.RT feed - 100ml milk 4th hrly,100 ml water 2nd hrly
2.INJ.LEVIPIL 500 MG /IV/BD
3.INJ.DEXAMETHQSONE 8 MG /IV/TID
4.IVF-NS@100ML/HR
INVESTIGATIONS
Treatment on 19/11/22
1.RT feed - 100ml milk 4th hrly,100 ml water 2nd hrly
2.INJ.LEVIPIL 500 MG /IV/BD
3.INJ.DEXAMETHQSONE 8 MG /IV/TID
4.IVF-NS@100ML/HR
Treatment on 20/11/22
1.RT feed - 100ml milk 4th hrly,100 ml water 2nd hrly
2.INJ.LEVIPIL 500 MG /IV/BD
3.INJ.DEXAMETHQSONE 8 MG /IV/TID
4.IVF-NS@100ML/HR
On 21/11/22
1.RT feed - 100ml milk 4th hrly,100 ml water 2nd hrly
2.INJ.DEXAMETHASONE 8 MG /IV/TID
3.IVF-NS@100ML/HR
4.TAB.RIFAMPICIN 600 MG
5.TAB.PYRAZINAMIDE 1200 MG
6.TAB.ISONIAZID 300 MG
7.TAB.ETHAMBUTOL 1100 MG RT/OD
On 22/11/22
1.RT feed - 100ml milk 4th hrly,100 ml water 2nd hrly
2.INJ.DEXAMETHASONE 8 MG /IV/TID
3.IVF-NS@100ML/HR
4.TAB.RIFAMPICIN 600 MG
5.TAB.PYRAZINAMIDE 1200 MG
6.TAB.ISONIAZID 300 MG
7.TAB.ETHAMBUTOL 1100 MG RT/
On 23/11/22
1.RT feed - 100ml milk 4th hrly,100 ml water 2nd hrly
2.INJ.DEXAMETHASONE 8 MG /IV/TID
3.IVF-NS@100ML/HR
4.TAB.RIFAMPICIN 600 MG
5.TAB.PYRAZINAMIDE 1200 MG
6.TAB.ISONIAZID 300 MG
7.TAB.ETHAMBUTOL 1100 MG RT/
