A 38 year old male with an episode of seizures

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Patient is a weaver by occupation living in a rural setup. 

 Chief complaints : Patient came to opd at 12 am with seizures( in an unconscious state). 

History of presenting illness: Patient apparently asymptomatic the night before admission. He had come along with his mother for a general check up( his mother had pedal edema). Patient went to sleep around 9pm at night and an episode happened around 12am midnight. The seizure characterised of involuntary movements of hands and legs and horizontal movements of head continuously. The episode lasted for about half an hour.then he was admitted and another episode occured after that( with same features). Patient was drowsy and blabbering until he regained consciousness( He doesn't remember this). 

History of past illness: Patient complains of excessive diarrhea( in the month of December last year)( approx. 4-5 times a day, right after consuming food, non blood stained and watery in consistency) He was treated accordingly and it has been managed.

Patient also complains of an increasing lump on his chest( mammary area, bilateral, increasing gradually in the span of 2 months, with no discharge) He went to a PHC 15 days ago and they reffered him to a specialist. 

Past history: Diagnosed With DM 1.5 years ago.N/k/c/o TB ,HTN ,Asthma, thyroid. Contracted covid in the first wave. 

Family history: Mother and sister both are Diabetic. Mother had right deviation of mouth and left leg paralysis. Now she's fine 

Surgical history: Patient underwent an eye surgery( left eye with discharge). 

Drug history : Insulin therapy, but patient was not taking his morning dose of insulin since 20 days). 

Personal history: Bowel and bladder movements normal. Sleep pattern normal. Decreased appetite and loss of weight. 

Daily routine:

Patient wakes up at about 7 am in the morning, has tea in the morning and sits down to work( weaving clothes). He doesn't have breakfast. Has lunch between 10-11 am( rice and dal, has curd occasionally). At 4pm he has tea with rusk(2-3) and 8 pm he has dinner( rice and doddhu rava).He goes to sleep at 10pm. He tells that he has difficulty in performing his normal activity since past 20 days. 

General examination:

Pallor -

Icterus -

Cyanosis - 

Koilonychia -

Lymphadenopathy -

Edema - 

Per abdomen- swelling at the nipples. 

Systemic examination

Cvs S1, S2 heat. Apex beat localised. 

Respiratory system:  BAE+, NVBS heard. 

Cns examination: HMF intact. No focal neurological deficit. 

Lab investigations

22/9/22

HbA1c - 7.5

Blood urea - 51

S. Creatinine 2.7

S. Na+ 139mmol/l

S. K+ 4.2mmol/l

S. Cl- 98mmol/l

23/9/22

Blood urea - 16

S. Creatinine 2.4

S. Na+ 140mmol/l

S. K+ 4mmol/l

S. Cl- 96mmol/l

USG:

Chest xray



Provisional diagnosis:

Hypoglycemic choreoathetosis????secondary to insulin overdose . Somogyi effect??? 

  

Treatmen

1. Inj. Actrapid SC

2.GRBS profile monitoring. 

3.Inj.optineuron 1amp NS 100ml IV