22 year old Female with C/O Pain abdomen and Vomitings.
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CASE PRESENTATION:
A 22 year old lady presented in the wee hours of Sunday with pain abdomen and vomiting.
The patient was apparently asymptomatic at 8 pm when she had her dinner as usual, a mix of rice, lentils, vegetable curry and curd and went to sleep at around 10 pm. She first developed pain at 2 am which was deep, pricking type, localising to the epigastrium. The pain then gradually worsened and she vomited all the food she had for dinner. She then had a few more episodes of greenish vomiting, which was bitter to taste. She says her vomiting mildly relieved her pain but it only came down from 8 or 9/10 to 6/10. The pain is constant and has no relieving factors. She says it is ggravted by food. She denies heartburn, hiccups, jaundice, constipation and diarrhea, malaena, or altered bowel habits in the past few weeks. She also denies any systemic symptoms in the past few weeks.
Review of systems is insignificant. However, her past history is significant for similar complaints in April when she was admitted here and was found to have a profound hypokalemia. She was discharged as APD.
Significantly 2 years ago, she developed a rapidly progressive quadriparesis in the wee hours of the night. The concerned family immediately took her to a hospital and she was found to have hypokalemia and she was immediately given IV potassium supplementation and the paresis quickly resolved. Since then, whenever she feels anxious, or exercises or feels stressed, she takes oral potassium supplementation.
She denies feeling weak on eating a good meal, or when doing strenuous work or with any acute stress.
The patient also has 'knock knees' which she herself reported to us, which her brother says have been since age 2 and nearly every youngster in her village has. He says they had been drinking fluorine rich water until her age was 10 but since then they have been drinking filtered water.
The family is very concerned as they're apprehensive about this condition affecting her marriage prospects.
general examination:
pallor-
icterus -
cyanosis -
clubbing -
lymphadenopathy-
oedema -
vitals
temp afebrile
bp 120/80mmhg
pr 95bpm
rr 18cpm
spo2 99%
GRBS 110mg/dl
systemic examination :
cvs :S1S2+
RS : BLAE+
P/A :Soft
Tenderness +
Around
Epigastric
Hypochondriac region
CNS :intact
Day 1:
Rx:
1.IVF ——— NS
RL @ 75 ml /Hr
2. Inj Pan 40 mg IV OD
3.Inj Zofer 4 mg IV BD
4.Inj Tramadol 1Amp in 100 ml NS IV SOS
Day 2:
Rx:
1. IVF ——— NS
RL @ 75 ml /Hr
2. Inj Pan 40 mg IV OD
3.Inj Zofer 4 mg IV BD
4.Inj Tramadol 1Amp in 100 ml NS IV SOS
5. Syp Potchlor 10 ml in a glass of water BD
Day 3:
Patient unable to sit/walk without support since morning
Diagnosis: Hypokalemic periodic paralysis secondary to hypokalemia.
O/e:
Patient is C/C/C
Afebrile to touch
Bp: 120/80 mm of hg
PR: 96 bpm
CVS: S1, S2 heard
RS: BAE +, clear
CNS: HMF intact
Power. Right. Left
UL. 3/5. 3/5
LL. 3/5. 3/5
Reflexes: Right. Left.
Biceps. 2+ 2+
Triceps. 2+ 2+
Supinator. 2+ 2+
Knee. 2+ 2+
Ankle. 2+ 2+
Plantar. ⬇️ ⬇️
Rx:
1. IVF ——— NS
RL @ 75 ml /Hr
2. Inj Pan 40 mg IV OD
3.Inj Zofer 4 mg IV BD
4.Inj Tramadol 1Amp in 100 ml NS IV SOS
5. Syp Potchlor 10 ml in a glass of water TID
Day 4:
Rx:
1. IVF ——— NS
RL @ 75 ml /Hr
2. Inj Pan 40 mg IV OD
3.Inj Zofer 4 mg IV BD
4.Inj Tramadol 1Amp in 100 ml NS IV SOS
5. Syp Potchlor 10 ml in a glass of water TID
6. Tab Nodosis 500 mg PO/ TID
Day 5:
Rx:
1. IVF ——— NS
RL @ 75 ml /Hr
2. Inj Pan 40 mg IV OD
3.Inj Zofer 4 mg IV BD
4.Inj Tramadol 1Amp in 100 ml NS IV SOS
5. Syp Potchlor 10 ml in a glass of water TID
6. Tab Nodosis 500 mg PO/ TID
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