A 30 yr old male with seizures

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Unit 1 admission 

Amc 3rd bed

A 30 year old male came to the OPD with the complaints of

Vomiting since 4 am yesterday

For 10 episodes

H/ o chronic alcoholic since 5-6 years more than180 ml / day

H/ O chronic smoker since 2 years

No pain abdomen

H/O sudden stoppage of consumption of  alcohol 20 days back for 4 days associated with 1 episode of seizure like activity with no history of trauma 

associated with facial puffiness 

on examination:  patient is c/c/c

congestion in both eyes 

Icterus  present 

black discoloration around eyes

Vitals : 

Afebrile

BP- 110/70

PR- 78bpm

CVS- s1,S2 heard

RS- BAE present ,NVBS

P/ A : soft , non tender

CNS: normal

Provisional diagnosis:

Alcohol withdrawal  seizure

Rt LL cellulitis

H/o head trauma

Investigations:

Hb-13.6

Tlc-6700

Plt-60,000

Lft

Tb-1.57

Db-0.48

Ast-70

Alt-115

Alp-165

Tp-6.7

Alb-3.8

A/g-1.35

Blood urea-15

S.crea-0.7

S.e

Na+--139

K+-4.1

Cl-92

On 14/09/21

Se

Na+ 137

K+ 3.6

Cl- 95

On 15/09/21

Hb- 14.2

Tlc- 5400

Plt- 60,000

Pcv- 38.6

Rbc- 4.46

Fbs- 86

Plbs- 107

Hba1c- 6.6

On 16/09/21

Serum electrolytes

Na+ 139 

K + 4 

Cl-  101

Chest x ray

 

Ecg

CT brain

Usg abdomen

X ray foot

Treatment given 

DAY 1

1) INJ THIAMINE 2 AMP IN 100 ml NS

2)INJ  OPTINEURON 1 AMP IN 100 ml NS

3) IVF

4)INJ PAN 40 mg IV / OD

5) INJ ZOFER 4 mg IV / BD

6)INJ LORAZEPAM 2 mg  IV/ SOS

7) INJ LEVIPIL 500 mg IV/ sos

8) MOXIFLOXACIN DROPS 4 times/ day

9) INJ AUGMENTIN  1.2 g IV / BD

10) E/D  LUBREX EYE DROPS 4 times / day

DAY 2 

 1)INJ THIAMINE 2 AMP IN 100 ml NS

2)INJ  OPTINEURON 1 AMP IN 100 ml NS

3) IVF

4)INJ PAN 40 mg IV / OD

5) INJ ZOFER 4 mg IV / BD

6)INJ LORAZEPAM 2 mg  IV/ SOS

7) INJ LEVIPIL 500 mg IV/ sos

8) MOXIFLOXACIN DROPS 4 times/ day

9) INJ AUGMENTIN  1.2 g IV / BD

10) E/D  LUBREX EYE DROPS 4 times / day

Day 3 

1) IVF

2) INJ PANTOP 40mg IV/OD

3)INJ AUGMENTIN 625mg IV/ BD

4) INJ METROGYL 500 mg IV/ TID

5) INJ THIAMINE 1 AMP IN 100 ML NS IV/ TID

6) INJ LEVIPIL 500 mg IV/ BD

7) T. CHYMORAL FORTE 500 mg PO/ TID

8) T. ULTRACET PO/SOS

9) T. LIBRIUM 25 mg

10) T. DIVALPROATE SODIUM 500 mg PO/OD

11) T. BACFEN  XL 20 mg PO/ OD

12 ) NICOTEX GUMS 2mg TID/ SOS

13) INJ LORAZEPAM 1 AMP 4 mgIM/ SOS

Day 4

1) IVF

2) INJ PANTOP 40mg IV/OD

3)INJ AUGMENTIN 625mg IV/ BD

4) INJ METROGYL 500 mg IV/ TID

5) INJ THIAMINE 1 AMP IN 100 ML NS IV/ TID

6) INJ LEVIPIL 500 mg IV/ BD

7) T. CHYMORAL FORTE 500 mg PO/ TID

8) T. ULTRACET PO/SOS

9) T. LIBRIUM 25 mg

10) T. DIVALPROATE SODIUM 500 mg PO/OD

11) T. BACFEN  XL 20 mg PO/ OD

12 ) NICOTEX GUMS 2mg TID/ SOS

13) INJ LORAZEPAM 1 AMP 4 mgIM/ SOS