62/M Repeated Episodic Paralysis of Limbs.

 

Greetings to all my readers.

I am Saranya , a final year MBBS student.

This is an elog documenting the patients that I witness during my Clinical Postings to enforce a greater patient centered learning .

 DATED : 26th October 2021

CONSENT AND DEIDENTIFICATION : 

The patient and the attenders have been adequately informed about this documentation and privacy of the patient is being entirely conserved. No identifiers shall be revealed through out the piece of work whatsoever.

 

PRESENTING PICTURE OF THE PATIENT

A 62 year old man ,farmer by occupation, hailing from South India, presented to us on 23^rd of October 2021 with complaints of weakness of both lower Limbs till level of knee since the night before.

 

ELABORATING ON HIS PRESENTING COMPLAINT :

Although the present acute attack began just a night before the day of presentation of the patient to us ,his illness seems to date back to 2K18 when one fine day ,while at home ,after he came back from his daily field work, suddenly there was onset of weakness in both is lower Limbs, along with slurring of speech which continued for a duration of 2 days and then resolved post medications administered by the physicians at Gandhi Hospital.

Post this first episode of 2k18 ,he returned into his normal routine within 4 days ,and everything went unexceptional until 2k19 when a similar episode was witnessed by him again , but this time there was no slurring of speech.

Following the previous trend,he was hospitalized but was back to normalcy within the next 2 days.

The present acute episode happened in the late hours of 22^nd October 2021 .

 

DESCRIBING THE DAY ON WHICH THE LATEST EPISODE OOCCURED.

22 October 2021

He was mentally disturbed since the past one week due to the death of one of his close relative ,which the patient feels was responsible for him having accentuated his daily alcohol intake

On this day he had done quite a lot of work at his field and some other significant outdoor activity following which in the evening he came back home ,when he complains of having felt feverish.

Nevertheless he freshened up ,had his dinner, consumed about 100 _ of toddy and went to sleep.

He had got up once to pass urine when he did not feel anything abnormal in himself

But the second time when he felt the need of getting up once again to pass urine he realized what his left lower Limb did not have any strength at all ,in the next moment his right limb also felt weak

He also felt weakness in both his upper Limbs.

No problem was felt in speech or articulation

In this state he was brought to us,in the early hours of 23^rd October 2021.

 

CO MORBIDITIES :

He is not a K/C/O Hypertension,Diabetes Mellitus,Bronchial Asthma,Coronary Artery Diseases or Epilepsy.

 

He has normal appetite ,takes mixed diet,bowel and bladder normal, gets adequate sleep.

No known food or drug allergies.

 

ADDICTIONS :

Not a smoker.

He consumes toddy daily since the last 30 years ( 90 daily) But has increased his daily consumption since the last few weeks.

 

FAMILY HISTORY : No similar complaints in any of his relatives.

 

 GENERAL EXAMINATION :

ABNORMAL PARAMETERS IN THE LABORATORY WORK UP :

 

Serum Creatinine   2.2 mg/dl

Serum Potassium  2.4 mEq / l

Serum Magnesium 1.7 mg /dl

 

Total Bilirubin         1.15 mg/dl

Direct Bilirubin        0.36 mg/dl

Alkaline Phosphate  174 IU / L

 

CBP :

 

 

 

 DISCUSSION THREADS : 

* How to differentiate between similar presentations due to inflammation mediated attack on myelin sheath of nerve fibres and those due to electrolyte Imbalance?

 

* What is causing recurrent dyselectrolemia in the patient?