67 yr old M not responding to words, commands, unable to speak and swallow

 A 67 yrs old male came to opd with chief complaints  of  not responding to words and commands ,unable to swallow,unable to speak since 1 day (30/8/22).



History of present illness 

Patient was admitted with complaints of unable to speak,swallow and altered sensorium which was sudden in onset.

In 2012 he heart blocks  in two valves for which he underwent a PTCA  one Stent in one , 2 stents in other.

In 2022, he developed flank pain , pedal edema for which he went local hospital and diagnosed as renal failure for which is taking dialysis since February. 


Past history  


K/C/O hypertension, diabetes mellitus since 1998.

N/K/C/O of epilepsy, Asthma,tb 


Treatment history  

He had history  of PTCA surgery.

Underwent surgery for hypertensive retinopathy,  glaucoma. 


Family history 

Not relevant 


Personal history  


Diet veg

Appetite  decreased 

B&B movements Irregular

Sleep Disturbed 

Addictions  he was drinker stopped drinking 3 yrs back

  Smoker and stopped 15 yrs back



Dinner at 7 pm 


Sleeps by 9 pm 



GENERAL PHYSICAL EXAMINATION 



Patient is conscious  not coherent not cooperative. Not well  oriented to time place person . Moderately built and nourished 



Pallor  absent



Icterus absent 



Cyanosis absent 



Clubbing absent 



Lymphadenopathy absent 



Edema absent 



Vitals 



Temperature  afebrile



PR  108 bpm



RR 29cpm



BP 110/70 mmHg 


Spo2 97% at RA



Systemic examination 


CVS- S1 S2 heard, no murmurs 


RS- BAE ,NVBS 


PA- Soft and non tender 


CNS - E3 V1 M4

           speech no response

           Power moving all 4 limbs

           Tone increased in all 4 limbs

       Reflexes 

                        B.     T.    S.     A.    K.   P

        R.             +      +    -        +     +     flexion

        L.             +       +    -        +    +      flexion 


Sensory -  can't be elicited 



Investigations  







Provisional diagnosis 

CKD


Treatment  

RT FEEDS - 100ml of milk 5th hrly and 500ml water 2nd hrly

Fluid and salt restriction.

Inj meropenem 500mg IV BD

Inj Lasix 40mg Iv BD

Inj nicardia 10 mg RT TID

TAB neomol 1gm IV SOS 

TAB Nodosis  500mg  RT TID

TAB dolo 600mg RT TID 

TAB snelcal 500mg RT OD

Cap BIO D3 RT  weekly once





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